The National Palliative Care Research Center

Curing suffering through palliative care research.


J. Randall Curtis MD, MPH


University of Washington

Grant Year
Grant Term
2 years
Grant Type
Pilot & Exploratory Project Support Grant

Project Description
Using the Electronic Health Record to Identify and Promote Goals-of-Care Communication

Goals-of-care communication represents one of the most important aspects of palliative care, yet remains a major shortcoming in our current healthcare system. Electronic health records (EHR) provide a key opportunity to identify many patients who would benefit from goals-of-care discussions. This proposed pilot study builds on two of our most successful programs. First, we will use our quality improvement work with the EHR to identify our population of interest: hospitalized patients with serious illness (encompassing multiple acute and chronic illnesses) who do not have EHR documentation of a goals-of-care discussion. Second, we will evaluate our Jumpstart intervention, recently shown effective in the outpatient setting, that provides patient-specific information to clinicians, patients, and family members to prompt and guide goals-of-care discussions. This study will accomplish 3 aims. First, conduct a pilot randomized trial to evaluate feasibility and acceptability of using the EHR to identify eligible hospitalized patients and implement the intervention with hospitalized patients. We will randomize patients to intervention (n=75) or usual care (n=75). Second, we will evaluate the efficacy of the intervention for changing processes of care with the primary outcome of EHR documentation of a goals-of-care discussion. We will also assess other outcomes to ensure feasibility of outcome assessment. Third, we will conduct semi-structured interviews with 30 trial participants from the intervention group (10 patients, 10 family members,10 clinicians) to identify barriers and facilitators to implementation of the intervention in a future trial and into clinical practice. Although this proposal is built on two successful prior programs (one research and one quality improvement), the integration of their respective strategies produces an innovative approach to implementing a novel intervention within a targeted population of high need identified via automated EHR methods. Our findings will provide pilot data for development of an innovative hybrid effectiveness/implementation trial as the next step.


J. Randall Curtis, MD, MPH, completed medical school at Johns Hopkins University and internal medicine residency as well as pulmonary and critical care fellowship training at the University of Washington.  He also completed a two-year Robert Wood Johnson Faculty Scholar Program focused on palliative care research. He is currently a pulmonary and critical care physician and palliative medicine physician at Harborview Medical Center at the University of Washington.  He also holds the A. Bruce Montgomery – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine and he is the inaugural Director of the Cambia Palliative Care Center of Excellence at the University of Washington.  He has an active research program with over 15 years of funding from the National Institutes of Health and has also received funding from a number of foundations including the Cambia Health Foundation, Robert Wood Johnson Foundation, the Soros Open Society Institute, and the Greenwall Foundation.  His research focuses on improving palliative care for patients with critical illness and patients with chronic and life-limiting illnesses as well as patients’ families.  He has authored more than 250 peer-reviewed research articles and more than 150 editorials and chapters. He is also committed to mentoring in palliative care research and is the director of two T32 awards and a K12 award from the National Institutes of Health to train researchers of the future.  Dr. Curtis has been the recipient of several awards for his research and teaching in palliative and end-of-life care including the Sojourns Award from the Cambia Health Foundation, the Roger C. Bone Award for Advances End-of-life Care from the American College of Chest Physicians, the Grenvik Family Award for Ethics from the Society of Critical Care Medicine, and the American Academy of Hospice and Palliative Medicine Award for Excellence in Scientific Research in Palliative Care.  In 2017, he was named one of the 30 Visionaries in Hospice and Palliative Medicine by the American Academy of Hospice and Palliative Medicine.