Emergency Medicine Palliative Care Access (EMPallA): Impact of cancer vs end-stage organ failure on protocol adherence and palliative care discussions
Connie Yin1, MS2 (Medical Student); Corita Grudzen2, MD, MSHS, FACEP (PI)
1 University of Cincinnati College of Medicine, OH, 2 Ronald O. Perelman Department of Emergency Medicine, New York University Robert I. Grossman School of Medicine, NY
Introduction: Palliative care (PC) is an interdisciplinary approach to patient care that aims to relieve suffering and improve the quality of life (QOL) for patients with advanced illness (cancer or end-stage organ failure [ESOF]) and their caregivers. 70% of PC trials are conducted in cancer patients, therefore there is limited knowledge about the engagement with or content of PC visits for patients living with end-stage organ failure. Thus, we aim to examine differences in outpatient specialty PC monthly follow-up visits between cancer and ESOF enrolled patients in the EMPallA study.
Methods: EMPallA is a multicenter, parallel, two-arm randomized controlled trial of discharged Emergency Department (ED) patients comparing two models of palliative care: nurse-led telephonic case management and specialty, outpatient palliative care. Patients randomized to the outpatient arm are scheduled for monthly visits for six months and include both in-person and telehealth options. Patients are compensated for each visit attended, and after six months, patients can be referred to their own outpatient PC upon request. Prior to study inception, using the Delphi method, an outpatient PC checklist was created with four domains (physical, psychosocial, bedside, and spiritual) to track PC discussions at each of the six follow-up visits. The study team extracted enrollment data, visit attendance and PC domains data for the two groups from REDCap®, Epic®, and the outpatient provider-completed PC checklists. We used data visualization to initially assess the strength of the relationship between illness type (cancer vs ESOF) and checklist content. All analyses were conducted using R®, Version 1.74 (R Foundation for Statistical Computing).
Results: Out of 1049 patients randomized in the EMPallA trial, 518 patients were randomized to the outpatient PC arm. (Figure 1)
Conclusions: Cancer patients are more likely to attend PC visits compared to ESOF patients. As the EMPallA study remains ongoing and many patients have not reached visit six yet, data collection is ongoing. The study team will continue to monitor the study for changes in visit attendance and content between cancer and ESOF patients. In all visits thus far, we showed similar coverage in physical, psychosocial, and bedside domains between cancer and ESOF patients with decreasing focus on the spiritual domain in visits four, five, and six.
FUNDING ACKNOWLEDGEMENT: This work was (partially) supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (PLC-1609-36306).
DISCLAIMER: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
Contact Information: yinjx@mail.uc.edu
Key Words/Tags: Palliative Care, Emergency Medicine, Cancer, End-Stage Organ Failure