Last week we talked about a trial of a nurse and social worker outpatient palliative care intervention published in JAMA. This week, we talk about the other major palliative care trial of default palliative care consults for hospitalized older adults with COPD, kidney disease, or dementia, published in the same issue of JAMA. (See also our accompanying editorial, first author Ashwin Kotwal who joins today as a co-host, and a podcast I recorded with JAMA editor Preeti Malani). For context, listen to the prior podcast with Scott on “nudges” and prior podcast with Kate on who should get palliative care.

Three things I love about this podcast, and why you should listen. First, in our editorial, we expressed concern about the length of stay metric not being patient centric, though important for health systems focused on cost savings. It was refreshing to hear Scott and Kate express similar sentiments. Second, we wanted to know how the palliative care clinicians felt about the increased workload - and we had some glimpses into those experiences (and hope for a future publication that fleshes it out further). Finally, we heard about next steps and lessons learned, as though this was the largest pragmatic trial of palliative care to date, it isn’t their last. Much more to come. And next time maybe we really will play the game where every time the word pragmatic is mentioned you have to drink 🙂

And I get to play Phish, who Scott has seen about 100 times in concert. I saw them only twice. Once as an undergraduate at Michigan, in 1994. They played Hill auditorium and I signed up to be an usher. Can you imagine trying to usher Phish Heads to stay in their assigned seats? Yeah, no. Gave up at some point and joined them. Full electric experience. Second time was with Neil Young at the Bridge School Benefit at the Shoreline Amphitheater, California in 1998. That concert, entirely acoustic, was impressive in its sheer musical virtuosity. You're kind of naked playing acoustic like that. On today’s podcast you get me, not naked, though still only with 2 left fingers (hand still broken) on the guitar, playing “Miss You.”

-@AlexSmithMD

Additional links:

Trey Anasatsio playing Miss You alone and acoustic, start around 21 minutes for the lead in

Original article describing the potential for default options to improve health care delivery: https://www.nejm.org/doi/full/10.1056/NEJMsb071595

Scott on goals of care as the elusive holy grail outcome of palliative care trials (we discussed toward the end): https://www.nejm.org/doi/full/10.1056/NEJMp1908153

The protocol paper for REDAPS: https://www.atsjournals.org/doi/10.1513/AnnalsATS.201604-308OT

Big recently funded PCORI trial comparing specialist PC delivered by default vs. generalist PC following CAPC training + a different EHR nudge: https://www.pcori.org/research-results/2023/comparative-effectiveness-generalist-versus-specialist-palliative-care-inpatients

Kate’s “Palliative Connect” RCT: https://clinicaltrials.gov/study/NCT05502861?term=katherine%20courtright&rank=1

RCT of Default Inpatient PC Consults: Kate Courtright & Scott Halpern

GeriPal - A Geriatrics and Palliative Medicine Podcast