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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Algorithm Arm | Experimental | Participants received prognostic advice from a prognostic algorihm. |
|
| Clinician arm | Experimental | Participants recieved prognostic advice from another clinician. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Advice from the PiPS-B14 prognostic tool | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Probability of survival estimate | Clinicians' estimates of the probability of a patient surviving for two weeks (0-100%) | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette |
| Measure | Description | Time Frame |
|---|---|---|
| Participants' weighting policies (characteristics of the participants) | Participants' responses to demographic questions | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette |
| Participants' weighting policies (the advice itself) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Patrick Stone, MA MD FRCP | UCL (University College London) | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University College London | London | WC1E 6BT | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36444695 | Derived | Bruun A, White N, Oostendorp L, Vickerstaff V, Harris AJL, Tomlinson C, Bloch S, Stone P. An online randomised controlled trial of prognosticating imminent death in advanced cancer patients: Clinicians give greater weight to advice from a prognostic algorithm than from another clinician with a different profession. Cancer Med. 2023 Mar;12(6):7519-7528. doi: 10.1002/cam4.5485. Epub 2022 Nov 29. |
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Data (suitably anonymised) may be shared with other research groups if a reasonable request is submitted to and agreed by the CI
The data will become available after the publication of results and will be archived securely by the Chief Investigator for a minimum of 20 years from the declaration of end of study
The data will be shared upon reasonable request
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Sep 1, 2020 | Dec 16, 2021 | Prot_001.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Mar 26, 2021 | Sep 16, 2021 | SAP_000.pdf |
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| ID | Term |
|---|---|
| D003643 | Death |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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Participants were randomly assigned to one of two study arms and received advice reportedly from either a prognostic algorithm, or another clinician.
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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.
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| Advice from another clinician | Other | 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. |
|
Strength of the prognostic advice provided by the advisor (0-100%) |
| Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette |