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| Name | Class |
|---|---|
| University of Bergen | OTHER |
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Do very elderly adults wish intensive care in the event of acute life-threatening illness and are their next of kin able to predict these preferences?
Very elderly patients are a steeply increasing patient population in intensive care units (ICUs), but the overall benefit of intensive care for these patients remains controversial. Will ICU admission improve survival and quality of life, or will it prolong suffering and delay natural death? Little is known about very elderly Norwegians life sustaining treatment (LST) preferences in these situations where treatment benefit is uncertain.
This project aims to improve critically ill very elderly patients' ICU trajectories by bringing forth knowledge about their treatment preferences, their family members' ability to predict these preferences, and by directing attention to the challenges of consent to critical care in cases of medical uncertainty.
A selv administered, mailed survey will be distributed among 400 outpatients aged 80 years or older and their next of kin. Respondents will be recruited at the ophthalmologic, ear-nose-and-throat and orthopaedic outpatient clinics at Haukeland University Hospital Bergen, Norway.
The investigators developed and validated a survey tool for this purpose, containing 3 hypothetical scenarios of acute life-threatening illness. The scenarios are randomly chosen from 20 hypothetical patient histories and are representative for ICU admission diagnoses in Norway and Europe. The participants will be asked for treatment choices, i.e. wishing admission to intensive care or not. A response option 'not wishing to engage in the treatment decision' is also provided.
Furthermore, the questionnaire includes factors that may influence elderlies' treatment preferences and proxies' ability to predict these preferences including: demographics, religion, previous experience with and / or communication about critical illness, comorbidity, frailty, quality of life, and projections (i.e. the proxy's own treatment preferences).
The respondents are requested to explain their choices by free-text comments after each scenario. They are also asked to elaborate how they wish next-of-kin should contribute to decision making in these cases. Additional space for free-text comments is provided in the end of the questionnaire.
The study design is exploratory. Responses will be analysed with both quantitative statistics and qualitative methods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| very elderly outpatients | outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older |
| |
| proxy | next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| survey "Intensive care of very elderly: What do they wish for themselves?" | Other | self-administered mailed survey |
|
| Measure | Description | Time Frame |
|---|---|---|
| Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Three mutually exclusive answer options in three randomly assigned clinically scenarios of acute critical illness in advanced age
| within 2 weeks of recruitment / upon completion of the questionnaire |
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Inclusion Criteria: Outpatients aged 80 years or older who register for appointment at the ophthalmologic, ear-nose-and-throat, and orthopaedic outpatient clinic at Haukeland University Hospital, Bergen, Norway.
Exclusion Criteria:
not consenting to participate
living in permanent care facility / nursing home
not able to complete the questionnaire owing to:
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Community dwelling very elderly outpatients in the catchment area of Haukeland University Hospital, i.e. Greater Bergen Region, Western Norway.
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| Name | Affiliation | Role |
|---|---|---|
| Gabriele Leonie I Schwarz, MD | Haukeland University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Haukeland University Hospital | Bergen | 5021 | Norway |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42315742 | Derived | Schwarz GL, Sjobo BA, Skaar E, Miljeteig I, Kvale R, Flaatten H, Burns KEA, Han PKJ, Schaufel M. Intensive care under uncertainty: a qualitative study of how older patients and their relatives wish to contribute to decision-making. Eur Geriatr Med. 2026 Jun 18. doi: 10.1007/s41999-026-01523-w. Online ahead of print. |
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1043 very old outpatients were approached. The next-of-kin respondents were recruited by the enrolled very old respondents.
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| ID | Title | Description |
|---|---|---|
| FG000 | Very Elderly Outpatients | outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
| FG001 | Proxy | next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Very Elderly Outpatients | outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
| BG001 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Older Respondents Treatment Preferences in an Event of Acute Life-threatening Illness Warranting ICU Admission as Stated by Themselves and by Their Next of Kin Acting as Proxy | Three mutually exclusive answer options in three randomly assigned clinically scenarios of acute critical illness in advanced age
| Posted | Count of Units | Treatment preference statement | within 2 weeks of recruitment / upon completion of the questionnaire | Treatment preference statement | Treatment preference statement |
|
2 months
Participants were offered to connect by phone or e-mail in the event of discomfort or distress during survey completion.
All-Cause Mortality and Serious Adverse Events were not monitored.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Proxy | next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. G.L. Schwarz | Helse Bergen | 0047-55976850 | gabriele.leonie.schwarz@helse-bergen.no |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 6, 2021 | Dec 16, 2024 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Proxy |
next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
|
| OG001 |
| Proxy |
next of kin who likely would act as a proxy in a medical emergency, identified by the very elderly respondent survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey |
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 202 |
| EG001 | Very Elderly Outpatients | outpatients (eyes, ear-nose-and throat, orthopaedic outpatient clinics at Haukeland University Hospital, Bergen, Norway) aged 80 years and older survey "Intensive care of very elderly: What do they wish for themselves?": self-administered mailed survey | 0 | 0 | 0 | 0 | 0 | 153 |
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