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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT03850847
Other study ID # CE 18.323
Secondary ID
Status Active, not recruiting
Phase
First received
Last updated
Start date August 1, 2019
Est. completion date August 31, 2025

Study information

Verified date April 2024
Source Centre hospitalier de l'Université de Montréal (CHUM)
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Given how central Substitute Decision Makers (SDMs) are to the process leading to end of life decisions and sometimes, organ donation, it is striking how poorly understood this decision-making process is. A 2017 scoping review on the topic of soliciting SDM consent to organ donation reported on more than 168 studies covering a broad range of topics, including: SDM characteristics and predictors of consent; the process of soliciting consent; and the effect of the decision on subsequent process of care and on family well-being. An unexplored area, however, is factors - including modifiable factors - that influence SDM decision making at the end of life, which organ donation is part of, such as: responses to stress, support from extended families and friends, and personal beliefs about the ongoing medical conditions. This project seeks to fill this clear and important gap. In the ICU, at the end of life, SDMs are under incredible emotional distress, have often not eaten or slept properly for days preceding discussions about end of life and organ donation, and are also in the midst of grieving for their loved one. The time pressure poses challenges for SDMs' decision making. Thus, this study will investigate novel, potentially modifiable reasons for end of life decision so that we may better support this personally challenging and important decision, especially if organ donation decision interferes with the decision process. Primary objective: To investigate beliefs and experiences of SDMs involved in the decision-making process around withdrawal of life sustaining therapies . Secondary objective: To inform efforts to improve support for SDMs with the aim of improving the decision-making process end-of-life decisions, including when organ donation is involved.


Description:

A national multicenter multi-methods study with SDMs will be conducted in two steps. In Step 1, a semi-structured interviews with SDMs will be conducted. The sampling frame will balance interviews with those that were approached or not for organ donation, and consented or not to organ donation. Interviews will be informed by two complementary theoretical frameworks. Building on Step 1 results, in Step 2 a national telephone survey of SDMs will be conducted to test which factors are associated with end-of-life decisions.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 292
Est. completion date August 31, 2025
Est. primary completion date March 31, 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Substitute decision maker (SDM) and patients with at least 18 years old - SDM(s) of patients in the ICU with or without brain injury for whom withdrawal of life-sustaining therapies is considered or has been discussed. - SDM(s) of patients for whom death is expected to occur within approximately 1 hour after withdrawal of life-sustaining therapies - English or French speakers SDM(s) - SDM(s) reachable in ICU Exclusion Criteria: - SDM is not reachable after pre-consent in ICU (after 5 initial attempts within a 3-week period). - SDM asks to postpone the interview more than 3 times. - SDM unable to provide informed verbal consent for any reason.

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Step 1: Semi-structured Interviews
Cover SDMs' experience around: withdrawal of life sustaining therapies organ donation among those who were approached (including with the medical team and the organ donation organisation) understanding of the situation views on any gaps in the quantity or quality of information and discussion they received concerning their loved one's end-of-life care or donation process Explore factors they perceived to influence their decision to consent to organ donation or not (or that would have influenced their decision for those not approached), and how such factors may have changed over the course of making this decision and since the decision (or since the event for those not approached).
Step 2: National Telephone Survey
Explore SDM's beliefs and experiences around end of life and assess which beliefs are associated with the decision taken at the end of life, including decision to donate organs or not (and the strength of this association)

Locations

Country Name City State
Canada Foothills Medical Centre Calgary Alberta
Canada Queen Elizabeth II Health Sciences Centre Halifax Nova Scotia
Canada Hamilton General Hospital Hamilton Ontario
Canada London Health Sciences Centre London Ontario
Canada Centre Hospitalier de l'Université de Montréal (CHUM) Montreal Quebec
Canada The Ottawa Hospital Ottawa Ontario
Canada CHU de Québec - Université Laval Quebec City Quebec
Canada Centre Hospitalier Universitaire de Sherbrooke Sherbrooke Quebec
Canada Winnipeg Health Sciences Centre Winnipeg Manitoba

Sponsors (3)

Lead Sponsor Collaborator
Centre hospitalier de l'Université de Montréal (CHUM) Canadian Institutes of Health Research (CIHR), Ottawa Hospital Research Institute

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary SDM's beliefs and experiences around end of life Assess which beliefs and experiences are associated with the decision to donate organs using open-ended questions. The responses obtained from the interviews will be analysed and classified based on the Leventhal's Common Sense Self-Regulation Model and the theoretical domain Framework. The most significant domains will help inform the creation of a larger scale national survey to help investigate what domains affect decision-making around end of life. 6 weeks to 2 months after patient's hospitalisation in the intensive care unit
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