ORaClES: A Trial to Improve Prognostication

Not Applicable

Completed

• Conditions: Terminal Illness

• Registration Number: NCT03360812
• Lead Sponsor: University College, London

Brief Summary

This study evaluates whether an online training resource can improve the performance of medical students in recognising imminently dying palliative care patients.

Detailed Description

Clinicians are routinely asked to provide survival estimates for palliative care patients, but recognition of imminent death (last 72 hours of life) is often inaccurate. We developed an online training resource, based on a previous study that identified the symptoms or signs that were most influential in forming expert palliative care doctors' prognostic decisions about imminent death.

This double-blind randomised controlled trial will evaluate the effectiveness of this online training resource in improving the performance of medical students in recognising imminently dying palliative care patients.

Participants are asked to visit the study website and review three series of vignettes describing patients referred to palliative care. For each vignette, participants are asked to provide an estimate (0-100%) about the probability that the patient will die in the next 72 hours. After the first series of vignettes, students randomised to the intervention arm are given access to an online training resource showing how experts weighted the relative importance of symptoms and signs. All participants are asked to complete a second series of vignettes. After two weeks, all participants are asked to return to the website and complete a third series of vignettes to assess if any effect has been maintained.

Study Timeline

• Study First Submitted: 2017-11-23
• Study First Submitted QC: 2017-12-01
• Study First Posted: 2017-12-04
• Study Start: 2018-04-05
• Primary Completion: 2018-07-27
• Study Completion: 2018-08-12
• Status Verified: 2020-04
• Last Update Submitted: 2020-04-07
• Last Update Posted: 2020-04-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 170

Inclusion Criteria

1. Over 18 years of age
2. Enrolled on a registered medical course within the United Kingdom
3. In the penultimate or final year of medical school
4. Sufficient English language proficiency
5. Willing and able to provide consent as indicated by taking part in the online survey

Exclusion Criteria

None

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Survival estimates - immediate effect	Second series of vignettes, taking into account the estimates from the first series. Students can participate at their convenience and will have a four week window to complete the first and second series of vignettes.	The primary outcome will be a continuous survival estimate provided from the students for the second series of vignettes; ranging from 0-100%.

Secondary Outcome Measures

Name	Time	Method
Survival estimates - follow-up	Third series of vignettes, taking into account the estimates from previous series. Two weeks after completing the first and second series of vignettes, students will be asked to complete a third series of vignettes within a four week window.	Survival estimates provided from the students at the two week follow-up; ranging from 0-100%.
Level of expertise	Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window.	The level of expertise will be assessed with the Cochran-Weiss-Shanteau (CWS) score. This score details the level of ability to discriminate and the level of consistency.
Cue weighting	Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window.	Cue weighting of the individual students as compared to the experts; that is the coefficient of each factor as part of their "judgement policy".

Trial Locations

Locations (5)

Brighton and Sussex Medical School; 🇬🇧 Brighton, United Kingdom

Hull York Medical School; 🇬🇧 Hull, United Kingdom

Imperial College London; 🇬🇧 London, United Kingdom

St George's Medical School; 🇬🇧 London, United Kingdom

UCL Medical School; 🇬🇧 London, United Kingdom