Effect of Intensivist Communication on Surrogate Prognosis Interpretation

Critical Illness Clinical Trial

Official title:

The Effect of Intensivist Communication on Prognosis Interpretation by Family Members of Patients at High Risk for Intensive Care Unit Admission: A Randomized Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04239209
• Other study ID #: IRB00204036
• Status: Completed
• Phase: N/A
• Start date: September 27, 2019
• Est. completion date: October 17, 2019

Study information

• Verified date: January 2020
• Source: Johns Hopkins University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study evaluates the effect of physician communication styles on the interpretation of prognosis by family members of chronically-ill patients. Participants were randomized to view one of four videos how depicting different physicians disclose prognosis when physicians expect an ICU patient to die.

Description:

Intensivist-surrogate discordance about prognosis is common in the intensive care unit. Minimizing discordance and empowering families to make informed decisions about participants' loved one's care is important, but it is unclear how best to communicate prognostic information to vulnerable surrogates when a patient is expected to die. Participants are randomized to view one of 4 intensivist communication styles in response to the question "What do you think is most likely to happen?": 1) a direct response (control), 2) an indirect response comparing the patient's condition to other patients, 3) an indirect response describing physiology, or 4) redirection to a discussion of patient values and goals.

The participant will then be asked a series of questions to measure participants' interpretation of what the intensivist says.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 302
• Est. completion date: October 17, 2019
• Est. primary completion date: October 17, 2019
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• spouse/partner, sibling, or adult child of a patient with Chronic Obstructive Pulmonary Disease (COPD) on home oxygen

• over age 18

Exclusion Criteria:

• ever working in healthcare as a nurse, advanced practice provider, or physician

Related Conditions & MeSH terms

• Critical Illness

Intervention

Behavioral:
• Indirect - other patients
Video depicting an indirect response focusing on a comparison to other patients.
• Indirect - physiology
Video of an indirect response focusing on the physiology of the patient.
• Redirection
Video of a redirection towards discussing the patient's values and possible future decisions.
• Direct communication
Video of a direct response.

Locations

Country	Name	City	State
United States	Johns Hopkins University	Baltimore	Maryland

Sponsors (2)

Lead Sponsor	Collaborator
Johns Hopkins University	Gordon and Betty Moore Foundation

Country where clinical trial is conducted

United States, 

References & Publications (31)

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Bahadori K, FitzGerald JM. Risk factors of hospitalization and readmission of patients with COPD exacerbation--systematic review. Int J Chron Obstruct Pulmon Dis. 2007;2(3):241-51. Review. — View Citation

Barnato AE, Arnold RM. The effect of emotion and physician communication behaviors on surrogates' life-sustaining treatment decisions: a randomized simulation experiment. Crit Care Med. 2013 Jul;41(7):1686-91. doi: 10.1097/CCM.0b013e31828a233d. — View Citation

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Boyd EA, Lo B, Evans LR, Malvar G, Apatira L, Luce JM, White DB. "It's not just what the doctor tells me:" factors that influence surrogate decision-makers' perceptions of prognosis. Crit Care Med. 2010 May;38(5):1270-5. doi: 10.1097/CCM.0b013e3181d8a217. — View Citation

Chiarchiaro J, Buddadhumaruk P, Arnold RM, White DB. Quality of communication in the ICU and surrogate's understanding of prognosis. Crit Care Med. 2015 Mar;43(3):542-8. doi: 10.1097/CCM.0000000000000719. — View Citation

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Glick DR, Motta M, Wiegand DL, Range P, Reed RM, Verceles AC, Shah NG, Netzer G. Anticipatory grief and impaired problem solving among surrogate decision makers of critically ill patients: A cross-sectional study. Intensive Crit Care Nurs. 2018 Dec;49:1-5. doi: 10.1016/j.iccn.2018.07.006. Epub 2018 Jul 26. — View Citation

Halpern SD, Becker D, Curtis JR, Fowler R, Hyzy R, Kaplan LJ, Rawat N, Sessler CN, Wunsch H, Kahn JM; Choosing Wisely Taskforce; American Thoracic Society; American Association of Critical-Care Nurses; Society of Critical Care Medicine. An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine. Am J Respir Crit Care Med. 2014 Oct 1;190(7):818-26. doi: 10.1164/rccm.201407-1317ST. — View Citation

Lee Char SJ, Evans LR, Malvar GL, White DB. A randomized trial of two methods to disclose prognosis to surrogate decision makers in intensive care units. Am J Respir Crit Care Med. 2010 Oct 1;182(7):905-9. doi: 10.1164/rccm.201002-0262OC. Epub 2010 Jun 10. — View Citation

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Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall JR, Dhainaut JF, Schlemmer B; French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med. 2001 Oct;29(10):1893-7. — View Citation

Schwarzkopf D, Behrend S, Skupin H, Westermann I, Riedemann NC, Pfeifer R, Günther A, Witte OW, Reinhart K, Hartog CS. Family satisfaction in the intensive care unit: a quantitative and qualitative analysis. Intensive Care Med. 2013 Jun;39(6):1071-9. doi: 10.1007/s00134-013-2862-7. Epub 2013 Feb 16. — View Citation

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White DB, Ernecoff N, Buddadhumaruk P, Hong S, Weissfeld L, Curtis JR, Luce JM, Lo B. Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients. JAMA. 2016 May 17;315(19):2086-94. doi: 10.1001/jama.2016.5351. — View Citation

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* Note: There are 31 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Participant confidence that they understood the intensivist's belief about prognosis.	Participant confidence in their ability to interpret the doctor's prognostic estimate of survival (primary outcome) using a 5-item Likert scale, measuring from not confident at all (1) to very confident (5).	approximately 5 minutes
Other	Participant confidence in their own prognostic estimate.	Participant confidence in their own estimate of their loved one's chances of survival to discharge using a 5-item Likert scale, measuring from not confident at all (1) to very confident (5).	approximately 5 minutes
Primary	Participant perception of the intensivist's prognostic estimate.	Participant response to the question "If you had to guess, what do you think the doctor thinks is the chance that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.	approximately 5 minutes
Secondary	Participant prognostic estimate.	Participant response to the question "What do you think are the chances that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.	approximately 5 minutes
Secondary	Participant difference in belief about prognosis.	This is the difference between outcome #2 (participant prognostic estimate) and outcome #1 (participant perception of the intensivist's prognostic estimate), expressed as a difference in percentage. In other words, if for a given participant outcome #2 was a 50% chance of survival and outcome #1 was a 30% chance of survival then outcome #3 (participant difference in belief about prognosis) would be 50% - 30% = 20%.	approximately 5 minutes

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