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We were really interested in the gap that exists after patients leave the ED or an observation status and go home, so what we did is we randomized patients, it was patient-level randomization, to either nurse-led telephonic care for six months, or specialty outpatient palliativecare for six months. Was this the same?
Well, it’s not an institutional factor, but institutions can either support having more palliativecare teams, better palliativecareresources, being palliativecare friendly or being less so. And palliativecare friendliness was definitely a very important factor to this.
So I think there’s definitely overlap with that, but I think helping patients cope, make priorities, think through their goals and values early and along the illness course does facilitate and enable better end of life decision making, including advanced care planning. And I do think that is the way of the future.
I have heard a lot of ACO people being very frustrated that they’re like, “We have this palliativecare program but there’s a three month waiting list. We don’t really have a palliativecareresource.” What’s the point? I just wanted to add that.
And yet in my other rotations and experiences, it was so clear that we were resourcing people with palliativecareresources very well. You didn’t have to walk many blocks down the street to a hospital or another facility where people were getting world class care. Naheed 16:20 Yeah. Naheed 21:58 Absolutely.
If we accept that frequent contact with palliativecare is the standard of care, and we’re trying to do something that entails less contact or less palliativecare, that’s the rationale for it being a non inferiority design, because we have to make the argument it’s no worse.
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