Critical Illness
Conditions
Brief summary
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.
Detailed 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.
Interventions
BEHAVIORALIndirect - other patients
Video depicting an indirect response focusing on a comparison to other patients.
BEHAVIORALIndirect - physiology
Video of an indirect response focusing on the physiology of the patient.
BEHAVIORALRedirection
Video of a redirection towards discussing the patient's values and possible future decisions.
BEHAVIORALDirect communication
Video of a direct response.
Sponsors
Gordon and Betty Moore Foundation
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Participants are randomized in a 1:1:1:1 ratio to view a video depicting one of four different ways intensivists answered a patient surrogate's prognostic question What do you think is most likely to happen? during a simulated ICU family meeting.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participant perception of the intensivist's prognostic estimate. | 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
| Measure | Time frame | Description |
|---|---|---|
| Participant prognostic estimate. | 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. |
| Participant difference in belief about prognosis. | 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
| Measure | Time frame | Description |
|---|---|---|
| Participant confidence that they understood the intensivist's belief about prognosis. | 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). |
| Participant confidence in their own prognostic estimate. | 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). |
Countries
United States
Outcome results
None listed