Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication for Older Patients with Serious Illness; Project to Improve Communication About Serious Illness – Hospital Study (PICSI-H)
Principal Investigator: JR Curtis
Research Grant: National Institute on Aging (NIA)
Older adults with chronic illness are especially vulnerable to non-beneficial intensive end-of-life care. To address this shortcoming, we have built on our previous intervention called “Jumpstart,” that promotes and enhances these discussions by using a summary form with feedback and recommendations. We will examine the effectiveness of this intervention for hospitalized older adults with chronic illness. We are conducting two linked, complementary randomized trials.
Trial 1, a pragmatic trial, compares usual care with a clinician-facing Jumpstart for hospitalized older adults with serious illness. The specific aims are: to evaluate the effectiveness of a the EHR-based (electronic health record) clinician Jumpstart guide, compared with usual care, for improving the quality of care; and 2) to conduct a mixed-methods evaluation of the implementation of the Jumpstart intervention, guided by the RE-AIM and CFIR frameworks for implementation science.
Trial 1 at clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT04281784
Trial 2, a comparative effectiveness trial, compares this clinician-facing Jumpstart with a patient-specific Jumpstart that goes to both clinicians and patients (or family members) based on surveys completed by patients or family members. The specific aims are: to evaluate the effectiveness of a survey-based patient/clinician Jumpstart guide compared to the EHR-based clinician Jumpstart guide for improving quality of care; and, to conduct a mixed-methods evaluation of the implementation of the intervention, guided by the RE-AIM framework for implementation science.
Trial 2 at clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT04283994
The primary outcome for both trials is documentation of a goals-of-care discussion during the patient’s index hospitalization.
Publications related to this study include:
Curtis JR, Lee RY, Brumback LC, Kross EK, Downey L, Torrence J, LeDuc N, Mallon Andrews K, Im J, Heywood J, Brown CE, Sibley J, Lober WB, Cohen T, Weiner BJ, Khandelwal N, Abedini NC, Engelberg RA. Intervention to Promote Communication About Goals of Care for Hospitalized Patients With Serious Illness: A Randomized Clinical Trial. JAMA. 2023 Jun 20;329(23):2028-2037.
Curtis JR, Lee RY, Brumback LC, Kross EK, Downey L, Torrence J, Heywood J, LeDuc N, Mallon Andrews K, Im J, Weiner BJ, Khandelwal N, Abedini NC, Engelberg RA. Improving communication about goals of care for hospitalized patients with serious illness: Study protocol for two complementary randomized trials. Contemp Clin Trials. 2022 Sep;120:106879. Epub 2022 Aug 10.
Abedini NC, Merel SE, Hicks KG, Torrence J, Heywood J, Engelberg RA, Kross EK, Curtis JR. Applying Human-Centered Design to Refinement of the Jumpstart Guide, a Clinician- and Patient-Facing Goals-of-Care Discussion Priming Tool. J Pain Symptom Manage. June 2021. Online ahead of print. [ https://doi.org/10.1016/j.jpainsymman.2021.06.012 ]