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This article was written by Kathryn Walker, PharmD and Hunter Groninger, MD.
In collaboration with investigators at the University of Pennsylvania, this NIH-funded research will examine a method for patients to get earlier access to palliative care services.
Palliative care services can provide holistic care coordination and symptom management support services that relieve the symptoms and stresses of serious illness for patients and their families. The earlier patients receive services, the more we can help—yet many palliative care programs are under-resourced, and not all patients have equal access to services.
Our research, funded by an R01 grant from the National Institutes of Health and in collaboration with the University of Pennsylvania Palliative and Advanced Illness Research (PAIR) Center, examines a new method that could help more patients access palliative care sooner.
Palliative care helps people with serious illnesses live better. It provides symptom management, care planning and coordination, emotional support, and communication for patients and their families. These services can be provided simultaneously as curative or disease-modifying treatment.
Studies have shown that when patients get palliative care early in the disease process along with standard treatment, they have:
- Improved quality of life and mood
- Measurably better ability to cope with their disease
- Higher likelihood of discussing end-of-life preferences with their doctors
- Reduced costs for the patient and health system due to fewer unnecessary hospitalizations
Our approach: Digital alerts to trigger palliative care consults.
With our collaborators from the PAIR Center, we’re conducting a five-year clinical trial to evaluate strategies to alert clinical teams to the opportunity for palliative care consultation.
Each of MedStar Health’s nine acute care hospitals will be randomly assigned to one of two strategies:
- Opt-in EHR notification: Originally launched at MedStar Health in April 2020, this strategy triggers an alert to the clinician when a patient meets predefined criteria for palliative care. They then decide whether to consult with the palliative care team.
- Opt-out EHR notification: If a patient meets the criteria to trigger an alert, the palliative care consultation request is submitted automatically. The medical team may decline the consultation if desired.
These alerts would be triggered if a patient meets criteria based upon their:
- Diagnosis with a severe illness
- Functional limitations
- Symptom management needs
- Use of hospital services like the emergency department
As we collect the data on how well each of these strategies performs, we’ll also talk with the patients, providers, and palliative care team to understand their lived experiences. Our goal is to explore how we can distribute palliative care services to the patients who need them most at the time they will be most effective.
Palliative care is a limited resource; we know more patients need our help than our teams can see. Sometimes, urgent treatment decisions mean requests for palliative care consultations wait until after they’re most helpful. What’s more, studies show that Black, Hispanic, and LGBTQ patients are less likely to receive these services than their white counterparts.
The large, diverse community surrounding MedStar Health provides an opportunity to hear from many patients and families about how best to serve everyone, regardless of disease, age, identity, or background. This research will help us extend our palliative care delivery to ensure more patients and families get the needed services.
