Improving Patient and Family Centered Care in Advanced Critical Illness

Completed · Not applicable

Conditions studied: Anxiety, Depression

In brief

One in five deaths in the U.S. occurs in or shortly after discharge from an intensive care unit (ICU), typically following decisions made by surrogate decision makers to forego life prolonging treatment. A large body of empirical research has identified deficiencies in care processes that contribute to three important problems: 1) family members often experience poor quality communication with ICU clinicians, leading to lasting psychological distress associated with the ICU experience; 2) patients near the end of life frequently receive invasive, expensive treatment that is inconsistent with their values and preferences, and 3) end-of-life care is a major contributor to health care costs.\[8, 9\] Although advance care planning can prevent some unwanted treatment, many patients wish for a trial of intensive treatment when the prognosis is uncertain, and therefore it seems likely that the need for interventions to improve "in-the-moment" decisions by surrogates will persist.\[10, 11\] In a pilot project, the investigators developed the PARTNER intervention (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building), an interdisciplinary intervention that 1) gives new responsibilities and advanced communication skills training to existing ICU staff (local nurse leaders and social work members of the ICU team); 2) changes care "defaults" to ensure frequent clinician-family meetings; and 3) adds protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician-family meetings. The objective of this proposal is to conduct a stepped wedge randomized controlled trial testing the PARTNER intervention in 5 ICUs among 1000 patients with advanced critical illness and their surrogates.

Key facts

Study ID

NCT01844492

Run by

University of Pittsburgh

People needed

1420

Starts

2012-07-23

Expected to finish

2016-02-18

Last updated by the study team

2018-03-20

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: accepted.

You may qualify if…

• 18 years of age or older
• Surrogate decision maker for ICU patient in one of 5 UPMC ICU's

You may not qualify if…

• Non-English Speaking
• Surrogate's loved one is for organ transplantation
• Not physically able to participate in family meeting

Where it is running

• University of Pittsburgh Medical Centers — Pittsburgh, Pennsylvania, United States

Full record on ClinicalTrials.gov

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