Barriers to recruitment into a randomized controlled trial comparing two modes of emergency department-initiated palliative care

Abstract Background: Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. Methods: Research coordinators monitored factors that prevented enrollment into a multi-site randomized controlled trial investigating two modes of community-based palliative care delivery for patients in the ED who are discharged home. Reasons for non-participation were documented and analyzed to identify themes within refusal data. Results: Enrollment rate across all sites was 45%. Of the 504 eligible patients who refused to participate, 237 (47.0%) refused due to barriers related to illness severity. Patients commonly refused due to misconceptions/stigma related to palliative care (123 [24.4%]). One-hundred forty-three patients (28.4%) refused due to the mode of palliative care delivery. Less commonly, patients refused due to general research barriers (16.5%), family/caregiver barriers (11.7%), and physician-related barriers (.1%). Discussion: Patients with advanced illnesses often refuse to participate in palliative care research due to the severity of their illness, misconceptions about palliative care, and the mode of care delivery. Robust training programs are crucial to overcome these misconceptions and to educate patients and providers about the role of palliative care. Future palliative care programs and study designs should recognize the burden this vulnerable population endures and consider alternative modes of care delivery in an effort to increase participation and enrollment. Clinical Trials Registration: NCT03325985, October 30, 2017, https://clinicaltrials.gov/ct2/show/NCT03325985Trial Time Period: March 28, 2018 – January 31, 2020

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Barriers to recruitment into a multi-site randomized controlled trial comparing the effectiveness of specialty outpatient versus nurse-led telephonic palliative care of older adults with advanced illness

10.21203/rs.3.rs-21202/v1 ◽

2020 ◽

Author(s):

Julia A Brickey ◽

Jeanne Cho ◽

Mara Flannery ◽

Corita R. Grudzen ◽

EMPallA Investigators

Keyword(s):

Older Adults ◽

Palliative Care ◽

Randomized Controlled Trial ◽

Hospital Admission ◽

Care Delivery ◽

Controlled Trial ◽

Advanced Illness ◽

Nursing Facility ◽

Randomized Controlled ◽

Ed Visits

Abstract Background Emergency department (ED) visits among older adults are common near the end of life. Palliative care has been shown to reduce ED visits and to increase quality of life among patients, but recruitment into these programs is often challenging. Methods A multi-site randomized controlled trial investigating two modes of community-based palliative care delivery for patients in the ED who are discharged home. Research coordinators monitored factors that prevented eligibility and enrollment by screening electronic health records to identify and recruit eligible patients and their caregivers. Reasons for ineligibility and non-participation were documented. Results Among the 7,091 patients who met the age and disease qualifier, 4,292 (60.5%) were deemed ineligible due to hospital admission. Additional reasons for ineligibility included previous palliative care (919 [13%]) or residence in a nursing facility (462 [6.5%]). Of the 695 patients who were eligible, 298 were enrolled, yielding an enrollment rate of 43% (range of 9% to 80% across all sites). Of the 397 eligible patients who did not participate, 180 (45.3%) refused due to barriers related to illness severity. Patients commonly refused due to misconceptions/stigma related to palliative care (118 [29.7%]). One-hundred fifteen patients (29%) refused due to the mode of palliative care delivery. Conclusions Hospital admission from the ED proved to be the most significant barrier to eligibility. Eligible patients often refused participation due to the nature of their illness, misconceptions about palliative care, and concerns about being able to attend clinic visits if assigned to the outpatient arm.

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P122: Emergency department length of stay for alcohol intoxicated patients presenting with head injury

CJEM ◽

10.1017/cem.2017.324 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S119

Author(s):

C. Varner ◽

S.L. McLeod ◽

C. Thompson ◽

B. Borgundvaag

Keyword(s):

Emergency Department ◽

Randomized Controlled Trial ◽

Head Injury ◽

Length Of Stay ◽

Alcohol Intoxication ◽

Controlled Trial ◽

Care Hospital ◽

Randomized Controlled ◽

Ed Visits ◽

Study Inclusion

Introduction: Excessive consumption of alcohol is associated with harm and responsible for up to 30% of emergency department (ED) visits. ED visits and length of stay (LOS) related to alcohol intoxication have increased over the last decade. The objective of this study was to compare the ED LOS of alcohol intoxicated and non-alcohol intoxicated patients presenting to the ED with acute head injury. Methods: This was a nested cohort analysis of patients screened for enrollment in a randomized controlled trial assessing minor traumatic brain injury (MTBI) discharge instructions in the ED of an academic tertiary care hospital (annual census 65,000). Patients aged 18 to 64 years presenting to the ED with a Canadian Emergency Department Information System (CEDIS) chief complaint of a head injury or suspected concussion occurring within 24 hours were eligible for study inclusion. Patients were identified as acutely intoxicated by their treating clinical providers. ED LOS for patients acutely intoxicated and those not intoxicated was compared using a Mann-Whitney U test using the Hodges-Lehmann method. Proportional differences were assessed using chi-square statistics. Results: A total of 164 patients were included in the analysis, 46 (28.0%) intoxicated and 118 (72.0%) not intoxicated. Median (IQR) ED LOS was 2.9 (1.5, 6.6) hours for intoxicated and 1.8 (1.3, 2.9) hours for non-intoxicated patients (Δ1.1 hours; 95% CI: 0.4, 1.8). Arrival by ambulance was higher in the intoxicated (73.9%) compared to the non-intoxicated (29.7%) group (Δ44.3%; 95% CI: 27.6, 57.1). Patients were more likely to have experienced assault in the intoxicated (34.8%) compared to the non-intoxicated (6.8%) group (Δ28.0%; 95% CI: 14.5, 42.8). There no difference in the proportion of patients who arrived after daytime hours, had a brain computed tomography, received analgesia in the ED, had another traumatic injury or had a history of psychiatric illness. Conclusion: One third of patients screened for a randomized controlled trial for MTBI were deemed ineligible for study inclusion due to acute alcohol intoxication. Alcohol intoxication was associated with prolonged ED LOS. Future studies specifically aimed at identifying factors that impact care on this frequent ED patient population are needed.

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