Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
SUSPENDED
Clinical Phase
NA
Total Enrollment
81 participants
Study Classification
INTERVENTIONAL
Study Start Date
2018-02-19
Study Completion Date
2022-06-30
Brief Summary
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This project will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion.
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Detailed Description
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Almost 1.8 million older Americans live in nursing homes (NH), with estimates that this number will grow to more than 3 million by 2050. NHs are increasingly becoming the place of care and site of death for frail older adults dying from multiple chronic illnesses. Unfortunately, most residents die without the benefit of palliative care (PC) or with palliation delayed until the last days of life.
Unfortunately, hospice services are often the only formal end of life care service available in NHs, and access to hospice enrollment is complicated by financial implications for both NHs and residents.
Telehealth, or remote monitoring of patients through information and communication technologies, is an effective mechanism for addressing the increased demand on health services and has much to offer to people living with and dying from advanced illness. Moreover, numerous studies have demonstrated positive benefits of using telehealth in the NH to improve access to consultants (e.g., neurology, dermatology, psychiatry).
Little is known, however, about the effect of using Telehealth on improving access to PC specialists in the NH setting.
The proposed ImPAcTT intervention employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities.
The investigator will conduct a pilot implementation trial of ImPAcTT in 3 study nursing homes to evaluate our ability to safely recruit and retain study participants, collect appropriate and accurate data, and determine preliminary estimates of an effect size of the intervention.
Unfortunately, hospice services are often the only formal end of life care service available in NHs, and access to hospice enrollment is complicated by financial implications for both NHs and residents.
Telehealth, or remote monitoring of patients through information and communication technologies, is an effective mechanism for addressing the increased demand on health services and has much to offer to people living with and dying from advanced illness. Moreover, numerous studies have demonstrated positive benefits of using telehealth in the NH to improve access to consultants (e.g., neurology, dermatology, psychiatry).
Little is known, however, about the effect of using Telehealth on improving access to PC specialists in the NH setting.
The proposed ImPAcTT intervention employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities.
The investigator will conduct a pilot implementation trial of ImPAcTT in 3 study nursing homes to evaluate our ability to safely recruit and retain study participants, collect appropriate and accurate data, and determine preliminary estimates of an effect size of the intervention.
Conditions
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Telehealth
Palliative Care
Study Design
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Allocation Method
NON_RANDOMIZED
Intervention Model
PARALLEL
The trial will be implemented in 3 nursing homes to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention.
Primary Study Purpose
SUPPORTIVE_CARE
Blinding Strategy
NONE
Study Groups
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ImPAcTT intervention
Within 48-72 hours of enrollment in the study, the primary participant and family will receive an ImPAcTT Telehealth visit with the PC provider. The provider will conduct a comprehensive PC assessment aligned with the National Consensus Project for Quality Palliative Care guidelines. Visits, which may include remote physical assessment using a digital stethoscope, dermatoscope, etc., will be documented and transmitted to the NH. Advanced Care Planning (ACP) and goals of care discussions will be facilitated by the ability to virtually share and edit documents, such as the Physician Orders for Life Sustaining Treatment (POLST), in real time with primary participants and/or family. The PC provider will conduct follow-up visits 1 week following the initial visit, then on a case-by-case basis.
Group Type
EXPERIMENTAL
Telehealth visit
Intervention Type
OTHER
ImPACTT Telehealth visit with the PC provider
Usual care
Participants will receive the standard of care established at the NH.
Group Type
NO_INTERVENTION
No interventions assigned to this group
Interventions
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Telehealth visit
ImPACTT Telehealth visit with the PC provider
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
Primary participant
* Age \>= 18 years
* English language fluency
* Palliative Care Consult Screening Tool (PCCS) scoring 9 or above
* If participant does not demonstrate capacity to consent, he/she must be able to assent to study procedures, be told of plan to approach surrogate and have a legally authorized representative available to provide consent
Family/friend caregivers:
* Closest relative/next of kin/friend who is involved in the care of his/her loved one before and during the study period
* English fluency
* Age \>= 18 years
* English language fluency
* Palliative Care Consult Screening Tool (PCCS) scoring 9 or above
* If participant does not demonstrate capacity to consent, he/she must be able to assent to study procedures, be told of plan to approach surrogate and have a legally authorized representative available to provide consent
Family/friend caregivers:
* Closest relative/next of kin/friend who is involved in the care of his/her loved one before and during the study period
* English fluency
Exclusion Criteria
Primary participant:
* Enrolled in hospice
* Unable to assent to study procedures
* Expresses resistance or dissent to participation or the use of surrogate consent
Family/friend caregiver:
* Life expectancy \< 1 year (e.g., metastatic cancer)
* Evidence of cognitive impairment or inability to consent to study procedures
* Enrolled in hospice
* Unable to assent to study procedures
* Expresses resistance or dissent to participation or the use of surrogate consent
Family/friend caregiver:
* Life expectancy \< 1 year (e.g., metastatic cancer)
* Evidence of cognitive impairment or inability to consent to study procedures
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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National Institute on Aging (NIA)
NIH
Sponsor Role
collaborator
University of Utah
OTHER
Sponsor Role
lead
Responsible Party
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Caroline Stephens
PhD, RN, GNP-BC, FAAN, Helen Lowe Bamberger Colby Presidential Endowed Chair in Gerontological Nursing, Associate Professor
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Caroline E Stephens, PhD, RN
Role: PRINCIPAL_INVESTIGATOR
University of Utah
Locations
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University of California San Francisco - UCSF
San Francisco, California, United States
Site Status
University of Utah
Salt Lake City, Utah, United States
Site Status
Countries
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United States
References
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Related Links
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https://www.capc.org/capc-reports-and-publications/
Improving palliative care in nursing homes \[online report\]. New York: Center to Advance Palliative Care. 2008.
https://us.sagepub.com/en-us/nam/basics-of-qualitative-research/book235578
Corbin J, Strauss A, Strauss AL. Basics of qualitative research. Sage; 2014.
Other Identifiers
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IRB_00129094
Identifier Type: -
Identifier Source: org_study_id
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COMPLETED
NA
Design and Testing of a Web-Based Tool for the Improvement of End-of-Life Planning in Patients With Advanced Cancer
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ACTIVE_NOT_RECRUITING
NA
Expanding Access to Home-Based Palliative Care
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TERMINATED
NA
Using Mixed-methods Approach to Explore Health Communication in Hospice Out-Patient Settings
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ENROLLING_BY_INVITATION
NA
Palliative Care Coaching for Families With Rare Advanced Lung Diseases
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COMPLETED
NA
Elaboration of a Multi-dimensional Indicator of Quality in Palliative Care
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COMPLETED
Oncology Associated Symptoms & Individualized Strategies
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WITHDRAWN
NA
Impact of Predictive Modeling on Time to Palliative Care in an Outpatient Primary Care Population
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COMPLETED
NA
Implication of a Mobile Team of Palliative Care and Reality of the Palliative Approach in the Units
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TERMINATED
Evaluation of Palliative Care Co-treatment by Attending Physicians and Nurses: an Online Survey as Part of the Project
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WITHDRAWN
Multidisciplinary Inpatient Palliative Care Intervention
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COMPLETED
NA
Building CAPACITI for Community-Based Palliative Care
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COMPLETED
NA
Telehealth in an Ambulatory Oncology Phase I Clinical Trial Unit
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COMPLETED
NA