The InterACT (Intervention for Appropriate Care and Treatment) study: working with clinical teams in hospitals to trial a feedback loop approach to promoting appropriate care and treatment for elderly patients at the end-of-life.
- Conditions
- End of life careAged carePublic Health - Health service research
- Registration Number
- ACTRN12619000675123
- Lead Sponsor
- Queensland University of Technology
- Brief Summary
Advances in medicine mean health care professionals can prolong life, yet some treatments have a low chance of providing real benefit to some patients. Hospitalisations for older people are becoming more common, with end-of-life care involving more interventions and often care that is non-beneficial to the patient. Addressing non-beneficial care is challenging, especially in large, complex hospitals. The InterACT trial built on previous research that looked at reasons why doctors sometimes provide treatment they know to be non-beneficial to patients, especially older patients who are near the end-of-life. The trial worked with clinical teams in three large tertiary hospitals in South-East Queensland that routinely care for patients 75 years and older. It used two tools to identify those patients at risk of receiving treatment that is not beneficial to them, then notified their doctors of this risk. The intent was that the doctors would start a conversation about appropriate care that was in line with the patient’s wishes and then update the patient’s advance care planning documents accordingly or complete a palliative care referral. The trial found that the intervention was not associated with any increase in completion or faster time to completion of these care review activities. The intervention also did not make much change to other measures including intensive care admissions, emergency calls, and length of hospital stay. Our results may be affected by some pandemic related challenges. The results, and what was learnt about the ‘nudge’ process, highlight some of the complexity involved in changing clinicians’ behaviour and attitudes toward end-of-life care and death and dying.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- All
- Target Recruitment
- 4677
Note that this study directly recruits clinical teams to participate not patients.
Inclusion criteria for Population 1, Clinical teams:
-be an established clinical team unit or specialty that routinely admits patients within the hospital
-include a nominated lead specialist consultant/s
-include a registrar/s and affiliated clinical nurse consultant or nurse unit manager
-have a clinical team structure and admission pattern typical of the hospital
-have a consistent history of admitting patients aged 75 years or over during a sample time period in the previous year
-participate in an information session with the project team.
Inclusion criteria for Population 2, patient data:
Patients admitted under the enrolled clinical teams and aged 75 years or over.
Inclusion criteria for population 3, (semi-structured interviews), Clinical teams, executive advisory group, site study team:
Enrolled clinical teams, hospital study executive advisory group and site study team members.
Clinical team exclusion criteria:
Excluded clinical teams will be those from the emergency department, any Intensive Care Units (ICUs), mental health units, and non-acute care and teams that do not meet all the inclusion criteria. While inappropriate treatment can occur in the ICU setting, we are choosing to study the feedback intervention with clinical teams that care for patients before they go to ICU.
Clinical teams that are already implementing an intervention or initiatives related to reducing non-beneficial treatments for older patients will be excluded.
Exclusion criteria patient data:
Patients <75 years of age or not admitted under the enrolled clinical teams.
Exclusion criteria, semi-structured interviews:
Clinical teams not enrolled in the intervention.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Proportion of patients with one or more Intensive Care Unit (ICU) admission. This will be assessed via data linkage to patient medical records.[ These data will be collected twice; once in week 1 of the usual exposure phase for the 2 years prior to day 1 of the usual exposure phase (historical data set), and once after week 58 (the end of all the trial phases).]
- Secondary Outcome Measures
Name Time Method