Emergency Medicine Palliative Care Access (EMPallA)

The study will perform a pragmatic, two-arm, multi-site randomized controlled trial of 1,350 older adults (50 years and older) with either advanced cancer (defined as metastatic solid tumor) or end-stage organ failure (New York Heart Association (NYHA) Class III and IV Heart Failure, End Stage Renal Disease defined as GFR < 15 ml/min/m2; or Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage III and higher or oxygen-dependent chronic obstructive pulmonary disease (COPD) defined as FEV1 < 50% or the mMRC dyspnea scale) who present to the Emergency Department (ED), along with 675 of their informal caregivers, to compare nurse-led telephonic case management to facilitated, outpatient specialty palliative care. The study will compare the effectiveness of two distinct palliative care models that vary by provider type (nurse versus physician-led) and mode of delivery (telephonic versus in-person): a) nurse-led telephonic case management; and b) facilitated, outpatient specialty palliative care.