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

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $628,823

## Abstract

ABSTRACT
The National Academy of Medicine and the National Institutes of Health have called for urgent
action to improve the care delivered to the nearly 1,000,000 older Americans who die in
intensive care units (ICUs) annually, or survive with substantial impairments. Major problems
include: (1) patients frequently die with distressing symptoms, receiving more invasive, life-
prolonging treatments than they would choose for themselves; (2) family members acting as
surrogate decision makers experience lasting psychological distress from the ICU experience;
and (3) life-prolonging treatments near the end of life contribute to high health care costs. One
potential strategy to address these shortcoming for older patients at high risk of death or
disability is the early integration of specialty palliative care (PC) alongside critical care.
However, there have been no high-quality randomized trials assessing whether integrating
specialty palliative care with standard critical care improves outcomes. We propose to address
this evidence gap by conducting a mixed-methods, multi-center randomized controlled trial
among 625 critically ill older adults with at least one suggested criteria for PC consultation.
Patients and their surrogate decision makers will be randomized to receive either early specialty
PC integrated with standard critical care or usual care, which includes timely clinician-family
meetings consistent with published recommendations. In Aim 1, we will determine effects of
specialty PC integrated with critical care on the co-primary outcomes of patient-centeredness of
care and surrogates’ psychological distress. In Aim 2, we will determine effects of specialty PC
integrated with critical care on three domains of secondary outcomes: patients’ outcomes,
families’ outcomes, and health care utilization. In Aim 3, we will conduct a parallel mixed
methods study to identify contexts and mechanisms that influence the efficacy of specialty PC
integrated with critical care among older critically ill patients. The research is highly significant
because it will determine whether a pragmatic, widely-available intervention is effective against
intractable problems near the end of life for nearly one million older Americans annually. It will
provide important information for healthcare systems and policy makers who are trying to
determine how best to allocate the effort of specialty PC consultants. This proposal is innovative
because it will provide the first high-quality evidence regarding the impact of specialty PC
integrated with critical care. The work is feasible in our hands because our team of established
investigators successfully has a proven record of success conducting multicenter ICU trials and
has buy-in for participation from all sites.

## Key facts

- **NIH application ID:** 10030184
- **Project number:** 1R01AG068567-01
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Yael Schenker
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $628,823
- **Award type:** 1
- **Project period:** 2020-09-15 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10030184

## Citation

> US National Institutes of Health, RePORTER application 10030184, Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Critically Ill Older Adults at High Risk of Death or Severe Disability (1R01AG068567-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10030184. Licensed CC0.

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