Intuition vs. Deliberation in Medical Decision Making

University of Pennsylvania

Status: Completed

Conditions: Decision Making About Life-sustaining Treatment in Patients With Serious Cardiac, Respiratory and Oncological Conditions Likely to Limit Life Expectancy

Treatments: Behavioral: Deliberative instructions; Behavioral: Cognitive load

Study type: Interventional

Funder types: Other

Identifiers

NCT02487810

UPenn 822238

Details and patient eligibility

About

The purpose of this study is to determine whether there are systematic differences between the decisions patients make intuitively versus deliberatively about life-sustaining medical therapies.

The targeted population is inpatients at the Hospital of the University of Pennsylvania with serious medical problems. The study will involve facilitated interviews with patients using a survey instrument developed in Qualtrics.

Enrollment: 200 patients

Sex: All

Ages: 60+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age 60 and older

2. Currently an inpatient at Hospital of the University of Pennsylvania

3. Speaks and reads fluently in English

4. Either

   1. Has one of the following medical conditions:

      • Chronic obstructive pulmonary disease with at least severe airflow obstruction on most recent spirometry and/or eligible for long-term oxygen therapy
      • Incurable interstitial lung disease with at least severe restriction on most recent pulmonary function tests and/or eligible for long-term oxygen therapy
      • Congestive heart failure with NYHA Class III or higher and current hospitalization related to heart failure
      • Acute myeloid leukemia
      • Stage IV lymphoma
      • Stage IIIB or Stage IV non-small cell lung cancer, cholangiocarcinoma, renal cell carcinoma, breast cancer, uterine cancer, cervical cancer, ovarian cancer, colorectal cancer, gastric cancer, pancreatic cancer, prostate cancer, urothelial cancer
      • Stage C or D hepatocellular carcinoma
      • Mesothelioma or any malignancy metastatic to the pleura; or

   2. Is hospitalized on oncology, pulmonary or cardiology service and has been hospitalized at least one other time during the last year on the same service

5. Stable vital signs

Exclusion criteria

1. Notation of code status limitation in electronic medical record
2. Cognitive impairment to the point unable to give informed consent
3. Current feeding tube placement
4. Current tracheostomy
5. Severe pain, shortness of breath or other uncontrolled symptoms
6. Actively undergoing evaluation for solid organ transplant
7. First hospitalization after diagnosis of serious illness

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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200 participants in 2 patient groups

Intuitive

Experimental group

Description:

Patients in each arm will be asked all of the same questions. The only difference between the arms will be the instructions regarding how and when to answer the series of hypothetical questions regarding medical interventions. The instructions will be designed to influence patients to think either intuitively or deliberatively about the questions regarding life-sustaining interventions.

Treatment:

Behavioral: Cognitive load

Deliberative

Experimental group

Description:

Patients in each arm will be asked all of the same questions. The only difference between the arms will be the instructions regarding how and when to answer the series of hypothetical questions regarding medical interventions. The instructions will be designed to influence patients to think either intuitively or deliberatively about the questions regarding life-sustaining interventions.

Treatment:

Behavioral: Deliberative instructions