Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Clinically Ill Older Adults at High Risk of Death or Severe Disability - Supplement

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ABSTRACT The National Academy of Medicine has identified improving clinicians’ serious illness communication skills (SICS) as a priority area to improve patient and family outcomes near the end of life. SICS are particularly important for hospitalized patients with moderate-to-severe Alzheimer’s disease or related dementias (ADRD) because: 1) patients’ preferences vary substantially regarding goals of care in this context; and 2) hospitalization often signals a worsening health trajectory with cascading readmissions and functional decline, and therefore presents an opportunity to engage in robust goals of care conversations. However, a critical barrier to achieving widespread improvements in this aspect of care for hospitalized ADRD patients is the absence of a scalable, empirically-validated way to help clinicians acquire the complex communication skills needed to engage patients and families in goals of care discussions in the hospital setting. The parent R01 on which this supplement builds is an RCT among critically ill older patients assessing the efficacy of an intervention involving goals-of-care conversations delivered by palliative care (PC) specialists to improve patient and family caregiver outcomes. The broad focus of both the parent R01 and this ADRD supplement is on caregiver support and patient-centered care through enhanced clinician-patient-caregiver communication. In light of the workforce shortages for PC specialists, improving the skills of non-PC specialists, which is the goal of the supplement proposal, is a critical strategy to increase care quality for hospitalized ADRD patients. Our goal is to create and disseminate a technology-enhanced intervention that is both scalable and empirically-validated to help hospital-based physicians and advanced practice providers (APPs) acquire the skills needed to effectively conduct goals-of-care conversations for hospitalized patients with ADRD and their families. Therefore, in Aim 1, we will use a nominal group process to engage a diverse stakeholder panel in the construction of the technology-enhanced SICS intervention for clinicians treating patients with ADRD. In Aim 2, we will conduct a single-arm pilot trial to evaluate the feasibility, acceptability, and efficacy (i.e., skills acquisition) of the SICS intervention. The proposed work will have high impact because it will yield the preliminary data needed for a successful R01 application to conduct an RCT to determine the impact of the scalable SICS intervention on the outcomes of hospitalized patients with ADRD and their caregivers. The project is innovative because it seeks to develop the first empirically-validated SICS intervention for clinicians of patients with ADRD that leverages technology to achieve high scalability. The work is feasible in our hands because we are a team of established investigators with a strong commitment to improving patient and caregiver outcomes in ADRD.