• Sarah K Andersen, Grace Vincent, Rachel A Butler, Elke H P Brown, Dave Maloney, Sana Khalid, Rae Oanesa, James Yun, Carrie Pidro, Valerie N Davis, Judith Resick, Aaron Richardson, Kimberly Rak, Jackie Barnes, Karl B Bezak, Andrew Thurston, Eva Reitschuler-Cross, Linda A King, Ian Barbash, Ali Al-Khafaji, Emily Brant, Jonathan Bishop, Jennifer McComb, ChangChung-Chou HCHDepartment of Medicine, Division of General Internal Medicine (E.R.-C., C.-C.H.C.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; The CRISMA Center, Department of Critical Care Medicine (I.B., C.-C.H.C.), U, Jennifer Seaman, Jennifer S Temel, Derek C Angus, Robert Arnold, Yael Schenker, and Douglas B White.
• Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine (S.K.A., G.V., R.A.B., E.H.P.B., D.M., S.K., R.O., J.S., D.B.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
• J Pain Symptom Manage. 2022 Jun 1; 63 (6): e601e610e601-e610.

BackgroundEach year, approximately one million older adults die in American intensive care units (ICUs) or survive with significant functional impairment. Inadequate symptom management, surrogates' psychological distress and inappropriate healthcare use are major concerns. Pioneering work by Dr. J. Randall Curtis paved the way for integrating palliative care (PC) specialists to address these needs, but convincing proof of efficacy has not yet been demonstrated.DesignWe will conduct a multicenter patient-randomized efficacy trial of integrated specialty PC (SPC) vs. usual care for 500 high-risk ICU patients over age 60 and their surrogate decision-makers from five hospitals in Pennsylvania.InterventionThe intervention will follow recommended best practices for inpatient PC consultation. Patients will receive care from a multidisciplinary SPC team within 24 hours of enrollment that continues until hospital discharge or death. SPC clinicians will meet with patients, families, and the ICU team every weekday. SPC and ICU clinicians will jointly participate in proactive family meetings according to a predefined schedule. Patients in the control arm will receive routine ICU care.OutcomesOur primary outcome is patient-centeredness of care, measured using the modified Patient Perceived Patient-Centeredness of Care scale. Secondary outcomes include surrogates' psychological symptom burden and health resource utilization. Other outcomes include patient survival, as well as interprofessional collaboration. We will also conduct prespecified subgroup analyses using variables such as PC needs, measured by the Needs of Social Nature, Existential Concerns, Symptoms, and Therapeutic Interaction scale.ConclusionsThis trial will provide robust evidence about the impact of integrating SPC with critical care on patient, family, and health system outcomes.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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