REDAPS
Trial question
What is the role of default palliative care consultation in hospitalized patients with advanced chronic illnesses?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
55.0% female
45.0% male
N = 24065
24065 patients (13338 female, 10727 male).
Inclusion criteria: hospitalized patients ≥ 65 years with advanced COPD, dementia, or kidney failure.
Key exclusion criteria: age < 65 years.
Interventions
N=10313 default order (a default palliative care consult order generated on the first full hospital day, which the clinician could cancel).
N=13752 usual care (receipt of usual care with no default palliative care consult order).
Primary outcome
Hospital length of stay
4.9 days
5 days
5.0 days
3.8 days
2.5 days
1.3 days
0.0 days
Default
order
Usual
care
No significant
difference ↔
No significant difference in hospital length of stay (4.9 days vs. 5 days; MD -0.53, 95% CI -3.51 to 2.53).
Secondary outcomes
Significant decrease in hospice discharge (6.8% vs. 6.9%; ARD -1, 95% CI -1.74 to -0.26).
Significant increase in DNR at discharge (37% vs. 30.2%; OR 1.4, 95% CI 1.21 to 1.63).
No significant difference in death in the hospital (4.7% vs. 4.2%; AD 0.5%, 95% CI -0.25 to 1.25).
Conclusion
In hospitalized patients ≥ 65 years with advanced COPD, dementia, or kidney failure, default order was not superior to usual care with respect to hospital length of stay.
Reference
Katherine R Courtright, Vanessa Madden, Brian Bayes et al. Default Palliative Care Consultation for Seriously Ill Hospitalized Patients: A Pragmatic Cluster Randomized Trial. JAMA. 2024 Jan 16;331(3):224-232.
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