Wide variation exists in the ways palliative care is delivered, but Penn Medicine is launching an extensive research project to determine best practices in the hospital setting.
A central question in the controlled randomized trial is whether patients would benefit more from expanded access to specialty palliative care versus care from generalists who receive a certain level of training.
A research team from the Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania will conduct the study, led by Dr. Scott D. Halpern, the John M. Eisenberg Professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, and Dr. Kate Courtright, an assistant professor of Pulmonary Medicine.
“As the need for palliative care continues to grow with the aging baby boomer population, it is critical to determine how to most effectively and equitably meet this need,” Halpern said in a statement. “With this large study, we hope to provide enough data to help health systems across the United States understand how to effectively scale and deliver palliative care so that it can have the greatest impact for all hospitalized patients.”
The Patient-Centered Outcomes Research Institute (PCORI) is financing the study through a $27.5 million grant.
The two-and-a-half-year clinical trial is expected to launch in autumn 2025. It will include more than 43,000 seriously ill patients admitted to 48 hospitals in 17 states who have at least a 50% chance of death within a year.
Among the participating hospitals, some will be selected to provide usual care. Others will develop interventions to train generalist clinicians to provide palliative care, and a third cohort will increase the availability of specialist palliative care consultation.
The study is designed to enroll a large, diverse cohort of patients, so that the investigators can also measure outcomes across subgroups, including race, gender, age, diagnosis and social determinants of health.
In addition to being one of the largest studies of its kind for palliative care, the project also represents one of the largest clinical trials to use a “Learning Health System” approach. This emerging model of continuous learning and improvement centers on the idea of systematically gathering and creating evidence and actively applying that knowledge to improve care.
“We expect this study to be a field-defining trial for inpatient palliative care going forward,” Courtright said. “We want all patients facing a serious illness to have access to high-quality palliative care and hope that this study will provide a step forward for health equity in palliative care delivery.”