Nudging Effective and Equitable Delivery of Specialty Palliative Care

Part of paid clinical trials in Washington D.C., District of Columbia.

Sponsor
University of Pennsylvania
Study ID
NCT06596577
Phase
PHASE3
Status
Enrolling By Invitation

Conditions

  • Palliative
  • Serious Illness

Eligibility Criteria

Sex
ALL
Age
18 Years - N/A
Healthy Volunteers
Not accepted

Interventions

  • Palliative care needs information — BEHAVIORAL
    clinician-directed EHR alert providing information about serious illness diagnosis(-es) and unmet palliative care needs
  • Default consult order — BEHAVIORAL
    clinician-directed EHR alert providing information about serious illness diagnosis(-es) and unmet palliative care needs + a choice to cancel the default palliative care consult order

Study Details

This stepped-wedge, cluster randomized pragmatic trial among 9 MedStar hospitals for patients with serious illness and unmet palliative care (PC) needs will test two interventions embedded within the electronic health record (EHR): (1) a PC needs triggered alert to opt-in to PC consults nudging hospital clinicians to order specialty PC consults for eligible inpatients, and (2) a palliative care needs triggered alert with an opt-out to palliative care consults. The trial will compare the interventions effects to usual care, focusing on completed PC consults during the hospital encounter and other secondary outcomes. The trial also includes an embedded mixed methods study to explore factors influencing the effectiveness and equity of intervention implementation.

Key Dates

Start date
Aug 6, 2025
Status verified
Sep 2025
Primary completion
Mar 1, 2028
Completion
Feb 28, 2029

Study Design

Enrollment
18,000 participants (estimated)
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH

Arms

  • Active Comparator: Palliative care needs information provision
    Clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs
  • Active Comparator: Palliative care needs information provision + default consult order
    The palliative care needs information provision intervention will be supplemented with a default palliative care consult order such that clinicians will receive an EHR alert providing information about a patient's serious illness diagnosis(-es) and unmet palliative care needs, and offered the choice to cancel the default consult order.
  • No Intervention: Control/Usual Care
    During the control phase, patients meeting eligibility criteria will be enrolled for study data collection but there will be no attempt to influence delivery of care. All hospitals will contribute a minimum of 9 weeks of outcomes data prior to adopting the intervention. The total duration of the control phase will differ for each hospital dependent on their randomly assigned time to adopt Intervention 1 in this stepped-wedge trial design.

Primary Outcome Measure

Inpatient palliative care consultation [ Time Frame: from enrollment up to 26 weeks ]

Locations (9)

FacilityCityStateZIPSite coordinators
MedStar Georgetown University HospitalWashington D.C.District of Columbia20007-
MedStar Washington Health CenterWashington D.C.District of Columbia20010-
MedStar Franklin Square Medical CenterBaltimoreMaryland21237-
MedStar Good Samaritan HospitalBaltimoreMaryland21239 ·-
MedStar Harbor HospitalBaltimoreMaryland21225-
MedStar Union Memorial HospitalBaltimoreMaryland21218-
MedStar Southern Maryland Hospital CenterClintonMaryland20735-
MedStar St. Mary's HospitalLeonardtownMaryland20650-
MedStar Montgomery Medical CenterOlneyMaryland20832-

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By research site
MedStar Georgetown University Hospital· Washington D.C., DCMedStar Washington Health Center· Washington D.C., DCMedStar Franklin Square Medical Center· Baltimore, MDMedStar Good Samaritan Hospital· Baltimore, MDMedStar Harbor Hospital· Baltimore, MDMedStar Union Memorial Hospital· Baltimore, MD

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