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Life sciences · Interventional Study
ClinicalTrials.gov · September 14, 2026
No summary has been generated for this record yet. What follows is drawn from its source metadata only.
Interventional Study.
No findings were extractable from the material analysed.
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
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Registry record from ClinicalTrials.gov (NCT07391956). This is a study registration, not published results. Lead sponsor: Icahn School of Medicine at Mount Sinai. Recruitment status: RECRUITING. Phase: NA. Study type: INTERVENTIONAL. Enrollment: 400 participants (ESTIMATED). Conditions: Advanced Heart Failure, Advanced Non-Colorectal Gastrointestinal Cancer, Advanced Lung Cancer, Advanced Triple Negative Breast Cancer. Interventions: BEHAVIORAL: Tier-Palliative Care; BEHAVIORAL: Community Health Worker. Primary outcome measures: Edmonton Symptom Assessment Scale (ESAS) , 12 months; Functional Assessment of Chronic Illness Therapy-Palliative Care Scale (FACIT-Pal) , 12 months; Patient-reported goals of care discussion , 12 months. Brief summary: TIER-PC is an adaptive model of delivering palliative care that provides the right level of care to the right patients at the right time. It represents an adaption of the Mount Sinai PALLIATIVE CARE AT HOME (PC@H) program, which delivers home-based palliative care. TIER-PC increases the number and intensity of disciplines added to the patient's care team as their symptoms worsen and function declines. In Tier 1, patients who are able to care for themselves and no/mild symptoms receive a community health worker (CHW) trained to elicit illness understanding in a culturally competent way. In Tier 2, for patients with poorer function and mild symptoms, a social worker (SW), trained in serious illness communication, joins the CHW to further elicit patients' goals and prognostic understanding while communicating symptom needs to their primary clinician. In Tier 3, as function decreases and symptoms increase, an advance practice nurse (APN) joins the CHW and SW to manage complex symptoms. Finally, in Tier 4, for those older adults with the poorest function and most complex symptoms, a physician joins the team to ensure that the most complex needs (e.g., end-of-life treatment preferences and multifaceted symptom control) are met. The CHW follows patients longitudinally across all tiers and re-allocates them to the appropriate tier based on their evolving needs.