PARTNER II: Improving Patient and Family Centered Care in Advanced Critical Illness

Not Applicable

Completed

Brief Summary: This is a stepped wedged randomized controlled trial comparing the PARTNER intervention with usual care in 5 Intensive Care Units. The overarching goal of this research project to ensure patient-centered decisions about the use of intensive treatments for patients with advanced critical illness. In a prior project, the investigators developed the PARTNER program (PAiring Re-engineered ICU Teams with Nurse-driven Education and OutReach), a 4-facet, team-based intervention that re-engineers how surrogates are supported in ICUs, including: 1) changing care "defaults" to ensure clinician-family meetings within 48 hours of enrollment and frequently thereafter; 2) protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician-family meetings, 3) increased use of palliative care services for patients with a poor prognosis. The investigators propose to begin deployment of the PARTNER II program in the spring of 2015 enrolling 690 surrogate decision makers in 5 ICUs using a stepped wedge design. The investigators expect to achieve the following project goals:

1. To increase the patient-centeredness of end-of-life decisions, and to increase the quality of clinician-family communication.

2. To decrease the psychological burden on family members acting as surrogates.

3. To reduce total health care costs by decreasing the duration of use of burdensome, invasive treatments at the end of life.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Behavioral: The PARTNER II Intervention	PARTNER II	The PARTNER intervention is a multifaceted intervention delivered by a trained "PARTNER Champion" who has undergone 16 hours of intense communication training, with audit and feedback, quarterly booster training, and expert implementation support. Additionally, there is academic detailing of ICU physicians and ICU bedside nurses to augment the intervention. The PARTNER Intervention deploys three strategies to improve: 1) the timeliness and frequency of clinician-family communication, 2) the emotional and decision support provided to families and 3) the appropriate involvement of palliative care specialists.

Primary Outcome Measures

Name	Time	Method
Quality of Communication (QOC) scale	At 6 months	We will assess quality of communication in family members in a telephone interview 6 months after enrollment using the validated13 item Quality of Communication Scale.

Secondary Outcome Measures

Name	Time	Method
Hospital Anxiety and Depression Scale	At 6 months	We will assess symptom burden of anxiety and depression in family members in a telephone interview 6 months after enrollment using the validated 14-item Hospital Anxiety and Depression scale (HADS).
Patient-Centeredness of Care Scale	At 6 months	We will assess Patient Centeredness of Care, using the 12-item Patient-Perceived Patient-Centeredness of Care Scale (PPPC) adapted for use by surrogates.
Intensive Care Unit Length of Stay	Participants will be followed for duration of ICU stay, an expected average of 21 days	We will assess the Intensive Care Unit length of stay as assessed by abstraction of this information from the medical record.
Impact of Events Scale	At 6 months	We will assess symptoms of post-traumatic stress in family members in a telephone interview 6 months after enrollment using the validated 22 item Impact of Events Scale.
Decision Regret Scale	At 6 months	We will assess Decisional Regret by family members in a telephone interview 6 months after enrollment using the validated 5 item Decision Regret Scale across treatment groups.

Locations (2): UPMC Hamot
🇺🇸
Erie, Pennsylvania, United States
UPMC Presby/Shady
🇺🇸
Pittsburgh, Pennsylvania, United States