In a single-site substudy of the PRIM-ER trial, an intervention to initiate palliative care in the emergency department did not increase the proportion of patients having goals-of-care conversations. However, when those conversations did occur, they frequently influenced patients’ care.
The article was published online ahead of print in Internal and Emergency Medicine.
PRIM-ER, an NIH Collaboratory Trial, was a stepped-wedge, cluster randomized trial of a palliative care training program in emergency departments in the United States. The program consisted of training in palliative care, simulation-based communication workshops, clinical decision support tools, and audit and feedback.
In the substudy led by Julia Murray of Ohio State University, which was conducted as a quality improvement initiative at a large academic medical center, the researchers wanted to explore whether the PRIM-ER intervention changed physician behavior at the institution. Although the proportion of critically ill patients having a goals-of-care conversation did not change, more than three-quarters of the patients who did have a conversation saw a change in code status, their care plan, hospice care, or updated advance care planning documents.
PRIM-ER was supported within the NIH Pragmatic Trials Collaboratory by a grant award from the National Institute on Aging. Learn more about PRIM-ER.