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Millions of Americans living with serious illness experience burdensome symptoms and receive aggressive care that is not aligned with their goals and preferences. A growing body of evidence suggests that palliative care, which entails a supportive approach to care focused on maximizing quality of life, improves patient-centered, clinical, and economic outcomes. For this reason, national guidelines recommend that clinicians provide palliative care themselves (“primary”) or consult a specialist (“specialty”) as a standard part of caring for seriously ill patients. Yet, many patients with life-limiting illness never receive palliative care, and for those who do, it is typically in the final weeks or days of life, thus limiting its benefits. While efforts focused on increasing specialty palliative care consultation seem sensible, this approach is limited due to a national palliative care workforce shortage. Novel approaches that promote primary along with specialty palliative care are needed. Further, relying on busy clinicians to reliably recognize patients likely to benefit from either primary or specialty palliative care is impractical and is an important source of inequities in palliative care delivery. Thus, this pragmatic clinical trial is being conducted at 6 Penn Medicine acute care hospitals to test a prognosis-triggered, clinician-directed behavioral intervention embedded within the electronic health record to nudge clinicians to either provide palliative care themselves (“primary”) or consult specialists (“specialty”) for seriously ill hospitalized patients. The study will evaluate the intervention’s effect compared to usual care on the primary outcome of hospital-free days through 6 months, and other patient-centered, clinical, and economic outcomes. The study also includes an embedded mixed methods study to understand clinician and hospital contextual factors that influence the intervention’s uptake. This study will provide high-quality evidence regarding the effectiveness of a low-cost, scalable approach to promote primary and specialist palliative care among a large and diverse patient cohort, advance the science of triggers for palliative care, provide new insights into patient groups most likely to benefit from systematic identification for palliative care, and create new knowledge about establishing hospital environments conducive to desired clinician behavior change to improve serious illness care.

Partnering Health Systems

Penn Medicine


National Institutes of Health (NIH)
National Institute on Aging (NIA)