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Completed

NCT Number: NCT04239209

Effect of Intensivist Communication on Surrogate Prognosis Interpretation

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.

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Key information

Conditions

Critical Illness Disease Attributes Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Johns Hopkins University

Baltimore, Maryland, 21287, United States

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Indirect - other patients

Behavioral

Video depicting an indirect response focusing on a comparison to other patients.

Indirect - physiology

Behavioral

Video of an indirect response focusing on the physiology of the patient.

Redirection

Behavioral

Video of a redirection towards discussing the patient's values and possible future decisions.

Direct communication

Behavioral

Video of a direct response.

Primary outcomes

  1. Participant perception of the intensivist's prognostic estimate.

    Time frame: approximately 5 minutes

    Participant response to the question "If you had to guess, what do you think the doctor thinks is the chance that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.

Secondary outcomes

  1. Participant prognostic estimate.

    Time frame: approximately 5 minutes

    Participant response to the question "What do you think are the chances that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.

  2. Participant difference in belief about prognosis.

    Time frame: approximately 5 minutes

    This is the difference between outcome #2 (participant prognostic estimate) and outcome #1 (participant perception of the intensivist's prognostic estimate), expressed as a difference in percentage. In other words, if for a given participant outcome #2 was a 50% chance of survival and outcome #1 was a 30% chance of survival then outcome #3 (participant difference in belief about prognosis) would be 50% - 30% = 20%.

Other outcomes

  1. Participant confidence that they understood the intensivist's belief about prognosis.

    Time frame: approximately 5 minutes

    Participant confidence in their ability to interpret the doctor's prognostic estimate of survival (primary outcome) using a 5-item Likert scale, measuring from not confident at all (1) to very confident (5).

  2. Participant confidence in their own prognostic estimate.

    Time frame: approximately 5 minutes

    Participant confidence in their own estimate of their loved one's chances of survival to discharge using a 5-item Likert scale, measuring from not confident at all (1) to very confident (5).

Sponsors and collaborators

Lead sponsor

Johns Hopkins University

Other

Collaborators

  • Gordon and Betty Moore Foundation

Registry information

Official study title

The Effect of Intensivist Communication on Prognosis Interpretation by Family Members of Patients at High Risk for Intensive Care Unit Admission: A Randomized Trial

Important dates

Study start
2019
Primary completion
2019
Study completion
2019
First posted
Jan 27, 2020
Registry last updated
Jan 27, 2020

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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