Clinical Surveillance Tool to Screen for Unmet Palliative Needs Among Patients in the Final Year of Life

Enrolling by invitation · Not applicable

Conditions studied: Palliative Therapy, Implementation Science, Screening, Terminal Care

In brief

One of the most important obstacles to improving end-of-life care is the inability of clinicians to reliably identify those who are approaching the end-of-life. Every aspect of a palliative approach to care - screening for unmet needs, treating symptoms, discussing goals of care, and developing a palliative management plan - depends on the reliable and accurate identification of patients with palliative needs. The investigators developed an accurate and reliable mortality prediction tool that automatically identifies patients in hospital at elevated risk of death in the coming year. In previous studies it has been shown that these patients also frequently have unmet palliative care needs at the time they are identified by the tool. This tool has been demonstrated feasible, acceptable to patients and providers, and effective for changing physician behaviour in an inpatient clinical context. In this project, this tool is implemented as part of an integrated knowledge translation project to facilitate reliable and timely identification of unmet palliative needs across multiple hospitals with different clinical settings and contexts. The investigators have partnered with 12 hospitals to improve the quality of palliative and end-of-life care provided to patients and families. With each partner site the investigators will develop a comprehensive implementation plan, including stakeholder engagement, education, and feedback. Process measures will be collected at each site to determine whether the tool was effective for promoting the identification and documentation of unmet palliative needs. Patients who were identified by the tool will also be followed over time to collect outcome and impact measures to see if their end-of-life care was affected by the intervention compared to control groups.

Key facts

Study ID

NCT04171830

Run by

Ottawa Hospital Research Institute

People needed

3536

Starts

2019-06-17

Expected to finish

2027-03-01

Last updated by the study team

2026-07-20

Who can join

Age: any. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• All newly admitted patients to selected medical units in participating sites during the 6-9-month intervention implementation period
• [To be assessed for unmet palliative needs] the patient must be competent and have the ability to participate in assessments (i.e. answer assessment questions and understand and speak sufficient English to participate).

You may not qualify if…

• N/A for mHOMR/HOMR-Now! intervention
• For palliative needs assessments: incapability of completing the ESAS and 4-Item ACP tools, either because of capacity/cognitive impairment or English-language ability.

Where it is running

• William Osler Health System — Brampton, Ontario, Canada
• Cambridge Memorial Hospital — Cambridge, Ontario, Canada
• Kingston Health Sciences Centre — Kingston, Ontario, Canada
• London Health Sciences Centre — London, Ontario, Canada
• Headwaters Health Care Centre — Orangeville, Ontario, Canada
• The Ottawa Hospital — Ottawa, Ontario, Canada
• Montfort Hospital — Ottawa, Ontario, Canada
• Queensway Carleton Hospital — Ottawa, Ontario, Canada
• Pembroke Regional Hospital — Pembroke, Ontario, Canada
• North York General Hospital — Toronto, Ontario, Canada
• Humber River Hospital — Toronto, Ontario, Canada
• Saint Michael's Hospital — Toronto, Ontario, Canada
• Windsor Regional Hospital — Windsor, Ontario, Canada

Full record on ClinicalTrials.gov

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