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Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT06463158
Other study ID # 0221-24-EP
Secondary ID
Status Not yet recruiting
Phase N/A
First received
Last updated
Start date June 17, 2024
Est. completion date October 31, 2025

Study information

Verified date June 2024
Source University of Nebraska
Contact Breanna Hetland, PhD
Phone 309-231-4537
Email breanna.hetland@unmc.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

BACKGROUND/PURPOSE: Engaging families in patient care during serious illness can enhance care quality, reduce social isolation, boost satisfaction, and lower healthcare costs. Active involvement of family caregivers in patient care remains limited because there are no evidence-based tools to guide clinicians on how to include them effectively. Therefore, the purpose of this study is to conduct a clinical trial that includes information developed while engaged in previous work related to the development and testing of a point-of-care technology that operationalizes caregiver involvement during acute hospitalization The investigators engaged in hypothesis driven customer discovery, then performed an iterative user centered design development and testing process, and now conclude with a clinical trial in the inpatient environment.


Description:

For this phase 1 clinical trial, the investigators will use a 2-stage sequential cohort design with repeated measures The investigators will recruit a total of 100 family caregivers of ICU patients from 5 ICUs at a single tertiary medical center over an 18-month period. A convenience sampling technique will be used to recruit participants in the control group (n=50) followed by participants in the experimental group (n= 50). Participants will be eligible if they are age 19 or older and at the patient's bedside during the patient's ICU admission. Data will be measured at 2 timepoints (study enrollment [T1] and within 48 hours of ICU discharge [T2]), with the primary endpoint (caregiver well-being) being measured more frequently (every 48 hours while the patient is admitted to the ICU). Data will be collected through structured interviews using pre-designed questionnaires. Patient specific data will be extracted via chart review from the medical record. The questionnaires will include items related to demographic variables, caregiver psychological distress, engagement, and satisfaction. Trained research assistants will conduct either face to face, virtual (via Zoom), or phone depending on the participant's preference and availability. During the first 8 months of recruitment, participants will be enrolled into the control group which consists of routine care and informational practices of the ICU team. During the last 10 months of recruitment, participants will be enrolled into the experimental group where they will receive the Family Room application on their personal devices. Conditions will be implemented in sequential order, not concurrently. This is a practical approach because it is reasonable to expect that only slight variations will exist between the demographics of the initial cohort (control condition) The investigators will test differential selection post hoc to identify whether the caregivers differentiated in any systematic way on variables that might be related to the intervention outcomes (professional caregiving experience, confidence in caregiving ability, patient's severity of illness, etc). In addition, the use of 5 different ICUs is intended to dampen any historical effects experienced within a single unit. Intervention Details (Family Room App). The Family Room is a dynamic, point of care tool that holds the power to profoundly change family caregiver involvement. It guides families on how best to contribute to patient care by providing real time education, a sense of connection, emotional support, and resources that enable meaningful caregiving. Importantly, family caregivers receive virtual training on comfort-focused care activities that can be done at the bedside, as well as a mechanism within the electronic health record (EHR) to measure and record the effectiveness of the care they provide. The app has been developed in partnership with nurses and family caregivers and will be connected with the EHR to ensure family caregivers' contributions are visible to all members of the health care team.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 100
Est. completion date October 31, 2025
Est. primary completion date October 31, 2025
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 19 Years and older
Eligibility Inclusion Criteria: - Participants will be eligible if they are age 19 or older - At the patient's bedside during the patient's intensive care unit (ICU) admission and are considered the patient's legally authorized representative (LAR) or designated caregiver who is able to make medical decisions on their behalf. Exclusion Criteria: -Located at the patient's bedside but is not their legally authorized representative (LAR) or designated caregiver who is able to make medical decisions on their behalf

Study Design


Related Conditions & MeSH terms


Intervention

Device:
Family Room App
The Family Room is a dynamic, point of care tool. It guides families on how best to contribute to patient care by providing real time education, a sense of connection, emotional support, and resources that enable meaningful caregiving. Importantly, family caregivers receive virtual training on comfort-focused care activities that can be done at the bedside, as well as a mechanism within the electronic health record (EHR) to measure and record the effectiveness of the care they provide.

Locations

Country Name City State
United States University of Nebraska Medical Center Omaha Nebraska

Sponsors (2)

Lead Sponsor Collaborator
University of Nebraska Gordon and Betty Moore Foundation

Country where clinical trial is conducted

United States, 

References & Publications (40)

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Goldfarb M, Debigare S, Foster N, Soboleva N, Desrochers F, Craigie L, Burns KEA. Development of a Family Engagement Measure for the Intensive Care Unit. CJC Open. 2022 Aug 5;4(11):1006-1011. doi: 10.1016/j.cjco.2022.07.015. eCollection 2022 Nov. — View Citation

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Hetland B, Bach C, Castner JP, et al. A randomized clinical trial to test a mobile application that supports family caregiver participation in patient care in the intensive care unit. Am J Respir Crit Care Med. 2023;207:A2507.

Hetland B, Bach C, Grotts E, et al. Development of a Mobile Application to Promote Family Caregiver Engagement in the Assessment and Management of Patient Symptoms During Mechanical Ventilation in the Intensive Care Unit (ICU). Am J Respir Crit Care Med. 2021;203:A1090.

Hetland B, Hickman R, McAndrew N, Daly B. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses. AACN Adv Crit Care. 2017 Summer;28(2):160-170. doi: 10.4037/aacnacc2017118. — View Citation

Hetland B, McAndrew N, Perazzo J, Hickman R. A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses. Intensive Crit Care Nurs. 2018 Feb;44:67-75. doi: 10.1016/j.iccn.2017.08.008. Epub 2017 Nov 21. — View Citation

Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Pozehl BJ, Heusinkvelt JM, Camenzind CE. Family Caregiver Preferences and Contributions Related to Patient Care in the ICU. West J Nurs Res. 2022 Mar;44(3):214-226. doi: 10.1177/01939459211062954. Epub 2021 Dec 14. — View Citation

Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Turnbull AE, Pozehl BJ, Heusinkvelt JM. Relationships among Demographic, Clinical, and Psychological Factors Associated with Family Caregiver Readiness to Participate in Intensive Care Unit Care. Ann Am Thorac Soc. 2022 Nov;19(11):1881-1891. doi: 10.1513/AnnalsATS.202106-651OC. — View Citation

Hetland BD, Pozehl B, Kupzyk K, et al. The impact of family caregiver psychophysiological characteristics on the caregiver role in the intensive care unit. Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccmconference.2019.199.1_MeetingAbstracts.A4361

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Kleinpell R, Heyland DK, Lipman J, Sprung CL, Levy M, Mer M, Koh Y, Davidson J, Taha A, Curtis JR; Council of the World Federation of Societies of Intensive and Critical Care Medicine. Patient and family engagement in the ICU: Report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2018 Dec;48:251-256. doi: 10.1016/j.jcrc.2018.09.006. Epub 2018 Sep 8. — View Citation

Kleinpell R, Zimmerman J, Vermoch KL, Harmon LA, Vondracek H, Hamilton R, Hanson B, Hwang DY. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Crit Care Med. 2019 Dec;47(12):1692-1698. doi: 10.1097/CCM.0000000000004009. — View Citation

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McAndrew NS, Jerofke-Owen T, Fortney CA, Costa DK, Hetland B, Guttormson J, Harding E. Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs. Nurs Crit Care. 2022 May;27(3):296-325. doi: 10.1111/nicc.12564. Epub 2020 Oct 21. — View Citation

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* Note: There are 40 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Caregiver Engagement-Practical Aspects-FAMily Engagement (FAME) Tool The FAMily Engagement (FAME) questionnaire is an instrument developed to assess current family engagement practice. Items address key principles of family-centered care, such as dignity and respect, information sharing, participation, and collaboration. They also address family engagement domains, including family presence, family needs, communication and education, decision making, and direct care. A five-point Likert scale (1=strongly agree, 2=agree, 3=neutral, 4=disagree, 5=strongly disagree) is used for responses, which are then transformed to a 0-100 scoring system, with higher scores indicating greater engagement in care and lower scores indicating lesser engagement in care. The overall engagement score is calculated by dividing the sum of the scores by the number of questions answered, with the result ranging from 0-100. The FAME tool has high construct validity and can be completed in 3.33 minutes by family members. Taken at study enrollment and within 48 hours of ICU discharge
Primary Daily activity within the Family Room App Measuring the daily activity logged within the application at the bedside. Only being measured in the experimental group. Daily from enrollment in study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- Severity of Illness- Apache II Taken from the electronic health record. APACHE II (Acute Physiology and Chronic Health Evaluation II) is a severity-of-disease classification system used in the ICU. An integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death. Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- Presence of lines, tubes, equipment Taken from the electronic health record. Count of number of lines, tubes, equipment present on ICU patient Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- Glasgow Coma Scale (GCS) Nurse documentation of level of consciousness in the electronic health record. The Glasgow Coma Scale (GCS) is used to objectively describe the extent of impaired consciousness. The scale assesses patients according to three aspects of responsiveness: eye-opening, motor, and verbal responses.The total score ranges between 3 and 15, with 3 being the worst and 15 being the highest. Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- Pain Nurse documentation of patient pain in the electronic health record. Pain scores can range for 0 being no pain to 10 being the worst pain. Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- Richmond Agitation-Sedation Scale (RASS) Nurse documentation of patient agitation in the electronic health record. Documented with a RASS score (richmond agitation-sedation scale). Range of scale is a ten point scale, with -5 (being unarousable) to +4 (being combative). Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Primary Daily Patient Symptoms- CAM-ICU Confusion Assessment Method for the ICU (CAM-ICU). Taken from the electric health record. CAM-ICU is a valid and reliable delirium assessment tool. CAM-ICU is a tool to assess for the presence of delirium in ICU patients who are unable to talk. It involves a sedation assessment and a confusion assessment. The confusion assessment evaluates four features: acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness. A patient is considered to be confused if they have feature 1 plus 2 and either 3 or 4 present. The CAM-ICU score ranges from 0 to 4, with 4 being the most severe. Daily from enrollment in the study until ICU discharge, assessed up to 16 months
Secondary Caregiver well-being- Screening Tool for Psychological Distress (STOP-D) 5 item screening tool which provides severity scores for each of the common psychosocial problem areas: depression, anxiety, stress, anger, and low social support. A recent study showed that the STOP-D is a valid screening tool for depression and anxiety when used in inpatient settings. Taken at study enrollment, then every 48 hours while patient is admitted to the ICU, and within 48 hours of ICU discharge, up to study completion or about 16 months
Secondary Caregiver well-being- Caregiver Self-Assessment Questionnaire 18-item, caregiver self-report measure was devised by the American Medical Association as a means of helping physicians assess the stress-levels of family caregivers. Caregivers are asked to respond either "Yes" or "No" to a series of statements, simple scoring system allows family caregiver themselves to score their results and to determine whether or not they are highly stressed. Scores between 0-16 for "yes" responses, with a higher number meaning more stress. The questionnaire was normed on a small national sample of family caregivers (n=60); the reliability coefficient alpha was .78. Specific items were found to be predictive of caregiver stress. Taken at study enrollment and within 48 hours of ICU discharge
Secondary Caregiver Engagement -Psychological Experience- Caregiving Health Engagement Scale (CHE-s) 7 item multidimensional scale proposed to evaluate the impact of burden on different aspects of a caregivers life. A recent validation study showed solid evidence for the internal consistency and concurrent validity of the CHE-s. The CHE is scored based on a Likert-type scale. Caregivers respond to a series of statements, indicating their level of agreement or disagreement. The total score reflects the caregiver's overall engagement in healthcare. Higher scores indicate greater engagement. Taken at study enrollment and within 48 hours of ICU discharge
Secondary Caregiver Resilience- Connor-Davidson Resilience Scale (CD-RISC2) 2 item instrument that measures resilience, specifically as it relates to bounce back and adaptability. Good test-retest reliability, convergent validity, and divergent validity. Answers are on a 5-point scale response, not true at all=0, rarely true=1, sometimes true=2, often true=3, and true nearly all of the time=4. Higher scores indicating greater perceived resilience. Taken at study enrollment
Secondary Caregiver Preparedness-Preparedness for Caregiving Scale The Preparedness for Caregiving Scale is a caregiver self-rated instrument that consists of ten items that asks caregivers how well prepared they believe they are for multiple domains of caregiving. Preparedness is defined as perceived readiness for multiple domains of the caregiving role such as providing physical care, providing emotional support, setting up in-home support services, and dealing with the stress of caregiving. Responses are rated on a 5-point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared). The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score the more prepared the caregiver feels for caregiving; the lower the score the less prepared the caregiver feels. Taken within 48 hours of ICU discharge