Integrating Palliative Care Social Workers into Sub-Acute Settings: Feasibility of the ALIGN Intervention Trial (S825)

Abstract

1.Describe the justification for methodological approach in this pragmatic trial design.2.Discuss the justification for the ALIGN intervention and preliminary results of the intervention in the SNF setting. Sub-acute rehabilitation (SNF), intended for short stay care transitions, cares for 1/3 of older adults in the last six months of life with low penetration of hospice and palliative care. ALIGN (Assessing & Listening to Individual Goals and Needs) is a palliative care social worker led intervention aimed to improve quality of life (QOL), goals of care (GOC) alignment, and provide support to patients and caregivers. Determine the feasibility of conducting a trial of ALIGN in older persons and their caregivers admitted to SNF and conduct exploratory analysis of ALIGN vs usual care on patient goals of care alignment (curative, life-prolonging/rehabilitative, comfort), QOL (FACT-G), and caregiver reaction assessment (CRA) and burden (Zarit). To conduct a pilot pragmatic randomized step wedge design of the ALIGN intervention versus usual care in three SNFs with 120 older adults and caregivers (optional) admitted with advanced medical illness (LACE score >7) to determine feasibility and preliminary efficacy. To date, 362 SNF patients met illness criteria and the team was able to approach 127 patients within required 72 hours of admission. Enrollment rate for patients = 68%, caregivers = 36%. Caregivers are often not available to participate in-person, alternate approaches are being tested. Baseline GOC alignment = 50%. Baseline FACT-G = 70.0 (+16.9) demonstrating compromised QOL, CRA Self Esteem scale (1-5) = 1.8 (+0.5) showing some benefit finding, and Zarit = 14.5 (+9.2) showing moderate burden. A pragmatic trial of the ALIGN intervention is feasible and needed based on low GOC alignment, low QOL, and moderate caregiver burden.