Grant: Project Grant

One of the most important obstacles to improving end-of-life care is the inability of clinicians to reliably identify those who are approaching the end-of-life. Every aspect of a palliative approach to care - screening for unmet needs, treating symptoms, discussing goals of care, and developing a palliative management plan - depends on the reliable and accurate identification of patients with palliative needs. We developed an accurate and reliable mortality prediction tool that automatically identifies patients in hospital at elevated risk of death in the coming year. We have shown in previous studies that these patients also frequently have unmet palliative care needs at the time they are identified by the tool. We have successfully implemented this tool in 4 Ontario hospitals, and have shown that it is feasible, acceptable to patients and providers, and effective for changing physician behaviour in an inpatient clinical context. Recently, an additional 13 Ontario hospitals have started to implement the tool using site-specific, comprehensive implementation plans, including stakeholder engagement, education, electronic medical record integration, and peer-peer collaboration and learning. In this project, we propose to evaluate this tool in the 13 hospitals that have started implementation to facilitate reliable and timely identification of unmet palliative needs and improve the quality of palliative and end-of-life care provided to patients and families. The goal of this proposal is to systematically evaluate the barriers and facilitators to implementation given different clinical settings and contexts, and assess whether the tool was effective for promoting the identification and documentation of unmet palliative needs. We will also follow patients who were identified by the tool over time to collect outcome and impact measures to see if their end-of-life care was affected by the intervention.