Checklist-guided Shared Decision-making for Code Status Discussions in Medical Inpatients.

University Hospital Basel

Status: Completed

Conditions: Code Status Discussions With Medical In-patients

Treatments: Other: Checklist-guided shared decision-making

Study type: Interventional

Funder types: Other

Identifiers

NCT03872154

Code status 2019

Details and patient eligibility

About

This cluster-randomized, multicenter trial is designed to investigate the effect of checklist-guided shared decision-making including decision aids and communication of expected outcome on patients' decision regarding their code status, and at the same time, if it improves decision-making quality as judged by patient's decisional comfort, patient knowledge and involvement in decision-making and patient satisfaction. Patients in whom resuscitation is considered as futile will be treated separately in an ancillary project. In these patients a checklist to communicate the futility and the medical consequences will be used.

Enrollment: 2,663 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. physician level

   • residents on the medical wards will be the primary level of randomization.

2. patient level - any adult (>18 years) patient that is admitted for in-hospital care will be eligible.

Exclusion criteria

1. physician level

   • no exclusion criteria for physicians except if they refuse participation

2. patient level

   • patients unable to complete questionnaires or unable to follow code status discussions due to (1) intoxication, (2) paracusis; (3) serious psychiatric conditions (e.g., psychosis, depression with suicidal tendency, stupor), (4) cognitive impairment (e.g. dementia, delirium).
   • patients prior included in this study (i.e., patients who are hospitalized for the second time)

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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2,663 participants in 2 patient groups

Intervention

Experimental group

Description:

In this group (intervention), physicians will conduct checklist-guided shared decision making to determine the patient's code status. Additionally, physicians will be given a decision aid, which they are told to use to illustrate impact and outcome of in-hospital cardiac arrests. Ancillary project (patients considered as futile): In this group (intervention), physicians will conduct checklist-guided communication.

Treatment:

Other: Checklist-guided shared decision-making

Usual Care

No Intervention group

Description:

In this group (control), physicians will conduct code status discussions as usually.