MedTrace Logo

Integrating Palliative Care Social Workers Into Sub-Acute Settings: A Feasibility Trial

NCT03546920 · Status: COMPLETED · Phase: NA · Type: INTERVENTIONAL · Enrollment: 220

Last updated 2019-07-10

No results posted yet for this study

Summary

This is a feasibility trial utilizing a step wedge design of a social worker led palliative care intervention for 120 adult patients with advanced medical illness being cared for in a subacute nursing facility. Caregivers are also invited to participate.

Conditions

  • Advanced Medical Illness

Interventions

BEHAVIORAL

ALIGN Intervention Phase

Communication: The PCSW will follow this structured process to improve and facilitate communication for intervention patients. 1. Attend routine weekly facility-led rounds/meetings reviewing patients, their needs and attend discharge planning conference; 2. Visit with patient and caregiver after the discharge planning conference to ensure understanding of the plan of care; 3. Ensure all appropriate community programs (home health, community palliative care) have made contact and established care, assess the transition, and revisit domains from the initial assessment; 4. Suggest questions that need to be asked of community providers. Throughout the intervention, the PCSW will communicate updates from the visits to all involved providers. Visits will also focus on increasing goal alignment with the objective that all participants have a ROLT score that is most aligned. Visits will also explore goals of care; this includes completion or review of advance directives.

Sponsors & Collaborators

  • Kaiser Permanente

    collaborator OTHER

  • University of Colorado, Denver

    lead OTHER

Principal Investigators

  • Stacy M Fischer, MD · University of Colorado SOM

Study Design

Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Model
SEQUENTIAL

Eligibility

Min Age
65 Years
Sex
ALL
Healthy Volunteers
No

Timeline & Regulatory

Start
2018-01-08
Primary Completion
2019-06-16
Completion
2019-06-16

Countries

  • United States

Study Locations

More Related Trials

Read the full study record

This page highlights key information. For complete eligibility criteria, study locations, investigator contacts, and the full protocol, visit the original record on ClinicalTrials.gov.

View NCT03546920 on ClinicalTrials.gov