Effect of Intensivist Communication on Surrogate Prognosis Interpretation

Johns Hopkins University

Status: Completed

Conditions: Critical Illness

Treatments: Behavioral: Direct communication; Behavioral: Redirection; Behavioral: Indirect - physiology; Behavioral: Indirect - other patients

Study type: Interventional

Funder types: Other

Identifiers

NCT04239209

IRB00204036

Details and patient eligibility

About

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.

Full 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.

Enrollment: 302 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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302 participants in 4 patient groups, including a placebo group

Direct Communication (control)

Placebo Comparator group

Description:

A direct response where the intensivist acknowledges that he is not certain but believes the patient will not survive hospitalization.

Treatment:

Behavioral: Direct communication

Indirect - other patients

Active Comparator group

Description:

An indirect response describing the prognosis of other people similar to the patient in question.

Treatment:

Behavioral: Indirect - other patients

Indirect - physiology

Active Comparator group

Description:

An indirect response describing the severe physiologic abnormalities present in the patient and potential future problems.

Treatment:

Behavioral: Indirect - physiology

Redirection

Active Comparator group

Description:

Redirection to a conversation about the values of the patient and possible future decisions.

Treatment:

Behavioral: Redirection