Palliative Care Model for People With Advanced Heart Failure or Cancer

AI summary

From the trial's eligibility criteria. Machine-read from the registry text on this page, so it can be wrong. The registry text below and the trial team decide who can take part.

The trial is looking for adults in Manhattan with advanced heart failure or advanced lung or non-colorectal gut cancer who have been in hospital recently and can still function fairly well.

Age

18 years or older

Sex

All sexes can join

Disease stage

Advanced heart failure with two heart-failure hospitalizations in the last 12 months, or advanced lung or non-colorectal gastrointestinal cancer (pancreatic, gastric, hepatobiliary, small bowel, esophageal) with one hospitalization in the last 6 months. Activity level: KPS > 50% (ECOG 0, 1 or 2).

Earlier treatment

More than 2 outpatient MSHS visits in the prior 12 months. Cannot have had a ventricular assist device or a heart transplant, or be in hospice care before joining.

Biomarker or test result

Lung cancer with a driver mutation (for example EGFR) that gives a favorable outlook is excluded.

Main reasons for not taking part

• Both cancer and advanced heart failure
• Lung cancer with a driver mutation such as EGFR that gives a favorable prognosis
• Living in a facility (subacute rehab, long-term care, hospice)
• Receiving hospice care, or enrolled in another palliative care study
• Callahan 6-Item Cognitive Screening score of 3 or less

The registry criteria, word for word

What the trial wants to find out

TIER-PC is an adaptive model of delivering palliative care that provides the right level of care to the right patients at the right time. It represents an adaption of the Mount Sinai PALLIATIVE CARE AT HOME (PC@H) program, which delivers home-based palliative care. TIER-PC increases the number and intensity of disciplines added to the patient's care team as their symptoms worsen and function declines. In Tier 1, patients who are able to care for themselves and no/mild symptoms receive a community health worker (CHW) trained to elicit illness understanding in a culturally competent way. In Tier 2, for patients with poorer function and mild symptoms, a social worker (SW), trained in serious illness communication, joins the CHW to further elicit patients' goals and prognostic understanding while communicating symptom needs to their primary clinician. In Tier 3, as function decreases and symptoms increase, an advance practice nurse (APN) joins the CHW and SW to manage complex symptoms. Finally, in Tier 4, for those older adults with the poorest function and most complex symptoms, a physician joins the team to ensure that the most complex needs (e.g., end-of-life treatment preferences and multifaceted symptom control) are met. The CHW follows patients longitudinally across all tiers and re-allocates them to the appropriate tier based on their evolving needs.

The 2 groups in the trial

• Tier-Palliative CareTreatment being tested

  Patients/caregivers will be cared for by an interdisciplinary team that includes a social worker, nurse, community health worker, nurse practitioner, and physician.

• Usual CareNo study treatment, for comparison

  Patients will be cared for by the physician who treats their serious illness (cardiologist, oncologist, primary treating clinician) and other illnesses.