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This is a stepped wedged randomized controlled trial comparing the PARTNER intervention with usual care in 5 Intensive Care Units. The overarching goal of this research project to ensure patient-centered decisions about the use of intensive treatments for patients with advanced critical illness. In a prior project, the investigators developed the PARTNER program (PAiring Re-engineered ICU Teams with Nurse-driven Education and OutReach), a 4-facet, team-based intervention that re-engineers how surrogates are supported in ICUs, including: 1) changing care "defaults" to ensure clinician-family meetings within 48 hours of enrollment and frequently thereafter; 2) protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician-family meetings, 3) increased use of palliative care services for patients with a poor prognosis. The investigators propose to begin deployment of the PARTNER II program in the spring of 2015 enrolling 690 surrogate decision makers in 5 ICUs using a stepped wedge design. The investigators expect to achieve the following project goals:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | The control group will receive usual care, in which the frequency and content of physician-family communication is determined by the clinical team according to their usual practice. No study ICU has a protocolized approach to family communication and instead clinicians determine the timing and frequency of communication with families. All sites have palliative care services. | |
| Behavioral: The PARTNER II Intervention | Experimental | The PARTNER intervention is a multifaceted intervention delivered by a trained "PARTNER Champion" who has undergone 16 hours of intense communication training, with audit and feedback, quarterly booster training, and expert implementation support. Additionally, there is academic detailing of ICU physicians and ICU bedside nurses to augment the intervention. The PARTNER Intervention deploys three strategies to improve: 1) the timeliness and frequency of clinician-family communication, 2) the emotional and decision support provided to families and 3) the appropriate involvement of palliative care specialists. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PARTNER II | Behavioral | The PARTNER intervention is a multifaceted intervention delivered by a trained "PARTNER Champion" who has undergone 16 hours of intense communication training, with audit and feedback, quarterly booster training, and expert implementation support. Additionally, there is academic detailing of ICU physicians and ICU bedside nurses to augment the intervention. The PARTNER Intervention deploys three strategies to improve: 1) the timeliness and frequency of clinician-family communication, 2) the emotional and decision support provided to families and 3) the appropriate involvement of palliative care specialists. |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Communication (QOC) scale | We will assess quality of communication in family members in a telephone interview 6 months after enrollment using the validated13 item Quality of Communication Scale. | At 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital Anxiety and Depression Scale | We will assess symptom burden of anxiety and depression in family members in a telephone interview 6 months after enrollment using the validated 14-item Hospital Anxiety and Depression scale (HADS). | At 6 months |
| Patient-Centeredness of Care Scale |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | We will assess hospital mortality and 6-month mortality using hospital records, 6 month follow-up with surrogates, and the National Death Index in cases in which participants are lost to telephone follow up. | At 6 months |
| Katz Activities of Daily Living Scale |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Douglas B. White, MD, MAS | University of Pittsburgh | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UPMC Hamot | Erie | Pennsylvania | 16550 | United States | ||
| UPMC Presby/Shady |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 15090940 | Background | Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD; Robert Wood Johnson Foundation ICU End-Of-Life Peer Group. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004 Mar;32(3):638-43. doi: 10.1097/01.ccm.0000114816.62331.08. | |
| 9769276 | Background |
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| ID | Term |
|---|---|
| D001008 | Anxiety Disorders |
| D003863 | Depression |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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Stepped Wedge Design
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|
We will assess Patient Centeredness of Care, using the 12-item Patient-Perceived Patient-Centeredness of Care Scale (PPPC) adapted for use by surrogates. |
| At 6 months |
| Intensive Care Unit Length of Stay | We will assess the Intensive Care Unit length of stay as assessed by abstraction of this information from the medical record. | Participants will be followed for duration of ICU stay, an expected average of 21 days |
| Impact of Events Scale | We will assess symptoms of post-traumatic stress in family members in a telephone interview 6 months after enrollment using the validated 22 item Impact of Events Scale. | At 6 months |
| Decision Regret Scale | We will assess Decisional Regret by family members in a telephone interview 6 months after enrollment using the validated 5 item Decision Regret Scale across treatment groups. | At 6 months |
We will assess functional status of the patient using the validated Katz Activities of Daily Living Scale at 6 months. |
| At 6 months |
| Hospital Length of Stay | We will assess hospital length of stay by abstraction of this information from the medical record at hospital discharge. | Participants will be followed for duration of hospital stay, an expected average of 4 weeks. |
| Total Hospitalization costs | We will measure total hospitalization costs by aggregating each patient's total service specific costs, generated from hospital administrative records. | Inclusive of index hospitalization |
| 6-month health care utilization | We will assess patient health care utilization using hospital records and through validated methods to assess utilization using standardized interviews with surrogates at 6 months. | Inclusive of index hospitalization and 6 months follow up |
| Pittsburgh |
| Pennsylvania |
| 15216 |
| United States |
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