title: Emergency department-initiated palliative care for advanced cancer patients: protocol for a pilot randomized controlled trial.
abstract: BACKGROUND
  For patients with advanced cancer, visits to the emergency department (ED) are common. Such patients present to the ED with a specific profile of palliative care needs, including burdensome symptoms such as pain, dyspnea, or vomiting that cannot be controlled in other settings and a lack of well-defined goals of care. The goals of this study are: i) to test the feasibility of recruiting, enrolling, and randomizing patients with serious illness in the ED; and ii) to evaluate the impact of ED-initiated palliative care on health care utilization, quality of life, and survival.
  
  
  METHODS
  This is a protocol for a single center parallel, two-arm randomized controlled trial in ED patients with metastatic solid tumors comparing ED-initiated palliative care referral to a control group receiving usual care. We plan to enroll 125 to 150 ED-advanced cancer patients at Mount Sinai Hospital in New York, USA, who meet the following criteria: i) pass a brief cognitive screen; ii) speak fluent English or Spanish; and iii) have never been seen by palliative care. We will use balanced block randomization in groups of 50 to assign patients to the intervention or control group after completion of a baseline questionnaire. All research staff performing assessment or analysis will be blinded to patient assignment. We will measure the impact of the palliative care intervention on the following outcomes: i) timing and rate of palliative care consultation; ii) quality of life and depression at 12 weeks, measured using the FACT-G and PHQ-9; iii) health care utilization; and iv) length of survival. The primary analysis will be based on intention-to-treat.
  
  
  CONCLUSIONS
  This pilot randomized controlled trial will test the feasibility of recruiting, enrolling, and randomizing patients with advanced cancer in the ED, and provide a preliminary estimate of the impact of palliative care referral on health care utilization, quality of life, and survival.
  
  
  BACKGROUND
  Clinical Trials.gov identifier: NCT01358110 (Entered 5/19/2011).
authors: Brandon
authors: B
authors: Kandarian
authors: R Sean
authors: RS
authors: Morrison
authors: Lynne D
authors: LD
authors: Richardson
authors: Joanna
authors: J
authors: Ortiz
authors: Department of Emergency Medicine, New York University School of Medicine, Bellevue Hospital, 462 First Avenue, Room A345, New York, NY 10016, USA. corita.grudzen@nyumc.org.
authors: Corita R
authors: CR
authors: Grudzen
mesh_terms: D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D057194:Intention to Treat Analysis; D008495:Medical Oncology; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D009519:New York City; D010166:Palliative Care / Q000706:statistics & numerical data; D018579:Patient Selection; D010865:Pilot Projects; D011788:Quality of Life; D012017:Referral and Consultation; D012107:Research Design; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome