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Admission to the intensive care unit (ICU) is a common event in patients treated for solid tumors or hematologic malignancies. A volume-outcome relationship has been shown in these patients, with a mortality rate decreasing from 70% in low-volume centres to 30-40% in high-volume centres.
We hypothesize that providing the low-volume centres with assistance from experts working in high-volume centres for the management of critically-ill cancer patients can bring down mortality to the values seen in high-volume centres.
The main objective of this study is to evaluate whether combining three knowledge-transfer methods (videoconference-based forum, educational sessions, and dissemination of published work) increases the survival of cancer patients managed in low-volume centres to the values seen in high-volume centres.
The main endpoint is all-cause mortality at hospital discharge.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Comparator Arm | Other | Classic expertise (as routinely performed in the participating ICU) |
|
| Telemedicine-based intervention | Experimental | Telemedicine-based expert advice. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Telemedicine-based intervention | Other | Telemedicine-based intervention Multifaceted intervention including daily videoconferences with audit and feedback, educational interventions, and dissemination of published works |
| Measure | Description | Time Frame |
|---|---|---|
| All-cause mortality | at hospital discharge (up to 28 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of changes based on expert opinion | at 28 days | |
| Number of invasive diagnostic tests used | at 28 days | |
| Number of non-invasive diagnostic tests used |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Elie AZOULAY, Pr | Contact | +33142499421 | elie.azoulay@aphp.fr | |
| Matthieu Resche-Rigon, Pr | Contact | +33142499742 | matthieu.resche-rigon@u-paris.fr |
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Stepped wedge design
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| Standard of care arm | Other | Classic expertise (as routinely performed in the participating ICU) |
|
| at 28 days |
| Proportion of patients with non-invasive ventilation and/or high flow oxygen | at 28 days |
| Proportion of patients in whom the cause for ICU admission remained undetermined | at 28 days |
| Number of days without life-supporting interventions | at 28 days |
| Number of anti-microbial agents | at 28 days |
| Number of blood transfusions | at 28 days |
| Number of chemotherapy | at 28 days |
| Proportion of patients with antibiotic de-escalation | at 28 days |
| Duration of antibiotic therapy | up to 28 days |
| Length of ICU stay | at hospital discharge (up to 28 days) |
| Proportion of ICU-acquired events | at 28 days |
| Satisfaction of patients, intensivists, primary physicians, and expert. | Satisfaction will be assessed using a visual analog scale (VAS). The VAS is a scale ranging from 0 to 10, with a higher score indicating greater satisfaction. | at 28 days |