ImproveCare - The management of clinical uncertainty in hospital settings

Conditions

End of life care Not Applicable End of life care

Jonathan Koffman, Emel Yorganci, Fliss EM Murtagh, Deokhee Yi, Wei Gao et al. (13 authors)

Health Technology Assessment2019-10-0123 citations

Managing uncertain recovery for patients nearing the end of life in hospital: a mixed-methods feasibility cluster randomised controlled trial of the AMBER care bundle.

Koffman J, Yorganci E, Yi D, Gao W, Murtagh F, Pickles A, Barclay S, Johnson H, Wilson R, Sampson L, Droney J, Farquhar M, Prevost T, Evans CJ.

2019-08-1618 citations

10.1186/s13063-019-3612-0

Interventions

Randomisation was at the level of the cluster (NHS Trusts) which was performed by King's College Clinical Trials Unit. The four clusters were randomised prior to collection of data at sites, but after

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: Patient inclusion criteria: 1. Participants must be 18 or over 2. Participants can be female or male 3. Patients who are deteriorating 4. Patients whose situations are clinically uncertain, with limited reversibility 5. Patients at risk of dying during their current episode of care, despite treatment Relative inclusion criteria: Relative or close friends of the patients who fulfil the criteria above. Healthcare professional inclusion criteria: Working on the study wards.

Exclusion criteria

Exclusion criteria: Patient exclusion criteria: 1. Participants under 18 years old 2. Patients whose situations are clinically certain Relative exclusion criteria: Relatives or close friends of the patients who do not meet the inclusion criteria Healthcare professional exclusion criteria: Not working on the study wards

Design outcomes

Primary

Measure	Time frame
1. The effect of the AMBER care bundle is measured using the Patient/family anxiety and communication subscale of the Integrated Palliative care Outcome Scale (I-POS) at baseline, 3-5 days, 10-15 days 2. Patients reported experiences of health care are measured using the howRwe questionnaire at baseline, 3-5 days, 10-15 days	—

Secondary

Measure	Time frame
1. Cost of care is measured with the EQ-5D at baseline, 3-5 days, 10-15 days 2. Other subscales of the Integrated Palliative Care Outcome Scale (I-POS) questionnaire at baseline, 3-5 days, 10-15 days 3. What patients and carers value most about AMBER care bundle and how it may be working is assessed through qualitative interviews, focus groups and non-participatory observation of multidisciplinary team meetings 4. Patients views on how they feel about taking part in this study are collected at 3-5 days and 10-15 days Embedded qualitative study: Preferred place of death and whether this is realized, along with satisfaction which will be collected from the relatives of patients who have lost their lives is measured using the QUALYCARE postal survey.	—

Measure

Time frame

1. Cost of care is measured with the EQ-5D at baseline, 3-5 days, 10-15 days 2. Other subscales of the Integrated Palliative Care Outcome Scale (I-POS) questionnaire at baseline, 3-5 days, 10-15 days 3. What patients and carers value most about AMBER care bundle and how it may be working is assessed through qualitative interviews, focus groups and non-participatory observation of multidisciplinary team meetings 4. Patients views on how they feel about taking part in this study are collected at 3-5 days and 10-15 days Embedded qualitative study: Preferred place of death and whether this is realized, along with satisfaction which will be collected from the relatives of patients who have lost their lives is measured using the QUALYCARE postal survey.

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Countries

England, United Kingdom

Outcome results

None listed