Terminal Illness
Conditions
Keywords
Prognostication, Multidisciplinary teams, Judge-Advisor System, Palliative Care, End-of-life
Brief summary
This study investigates how clinicians form intuitive judgements about the prognoses of palliative care patients after receiving advice perceived as coming from either a team member or an algorithm.
Detailed description
Using the Judge-Advisor System, the investigators will recruit clinicians working in palliative care for adults. Participants will be asked to complete an online survey and review five patient summaries (vignettes) based on real cases derived from a previous study. Clinicians will be presented with key prognostic information and will be asked to provide an estimate of the probability that the patient will survive for two weeks (0-100%). After providing this initial estimate, participants will receive prognostic advice. While in reality all participants will receive the same advice, participants will be randomised into two groups and these groups will be informed that the advice is either: (1) provided by an algorithm; or (2) provided by a team colleague. Participants will then be given the opportunity to give a second, possibly revised estimate in the light of the advice received.
Interventions
OTHERAdvice from the PiPS-B14 prognostic tool
Participants were informed that prognostic advice came from the PiPS-B14 prognostic tool. PiPS-B14 is a validated prognostic algorithm that has been shown to be as accurate as an agreed multi-professional survival estimate. Participants were further informed that in a previous study the PiPS-B14 risk categories for predicting two-week survival were as accurate as a doctor's or a nurse's prediction.
OTHERAdvice from another clinician
Participants were informed that prognostic advice came from another clinician. Doctors were told that advice was from a nurse, whereas nurses or other types of HCPs were told that advice was from a doctor.
Sponsors
University College, London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
DOUBLE (Subject, Investigator)
Masking description
The research team and participants were blind to intervention allocation, whilst the database specialist was not blinded to allocation. Group allocation was only revealed once the database had been locked and analyses had been completed.
Intervention model description
Participants were randomly assigned to one of two study arms and received advice reportedly from either a prognostic algorithm, or another clinician.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Clinicians working in an adult palliative care service * Willing and able to provide written informed consent
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Probability of survival estimate | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | Clinicians' estimates of the probability of a patient surviving for two weeks (0-100%) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participants' weighting policies (characteristics of the participants) | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | Participants' responses to demographic questions |
| Participants' weighting policies (the advice itself) | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | Strength of the prognostic advice provided by the advisor (0-100%) |
Countries
United Kingdom
Outcome results
None listed