Mitigating Racial Disparities in Shared Decision Making in the Intensive Care Unit
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Health Care Disparities
- Sponsor
- Duke University
- Enrollment
- 106
- Locations
- 1
- Primary Endpoint
- Practicality as measured by proportion of screen eligible participants enrolled per month
- Status
- Not Yet Recruiting
- Last Updated
- 6 months ago
Overview
Brief Summary
This is a non randomized pilot trial aimed to:
Test the feasibility of an intervention to support intensive care unit clinicians in conducting shared decision making conversations with families of patients with acute respiratory failure. The goal of this intervention is to mitigate racial disparities in shared decision making.
Detailed Description
The care of critically ill patients with acute respiratory failure involves life-or-death decisions. Ideally, intensive care unit (ICU) clinicians should include patients or their families in shared decision making, which promotes goal-concordant care (i.e., care aligned with patients' preferences), reduces psychological distress for both families and clinicians, and shortens ICU length of stay. However, racial disparities have been documented in shared decision making and associated outcomes. In outpatient settings, clinicians treat Black patients differently from White patients, providing fewer treatment options, less prognostic information, and less emotional support, and making assumptions about rather than eliciting patient preferences. Disparities in shared decision making are likely to be amplified in the ICU because clinicians often do not have long-standing relationships with patients or families, and decisions are complex, emotional, and time-pressured. Yet, no interventions currently exist to address racial disparities in shared decision making about acute respiratory failure. This research will directly fill this gap.
Investigators
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Practicality as measured by proportion of screen eligible participants enrolled per month
Time Frame: through study completion, up to 1 year
Proportion screen eligible enrolled/month based on review of study logs, range 0 to 100%
Intervention acceptability as measured by single Likert-scaled item completed by physicians
Time Frame: within 96 hours of signing study consent
Likert-scaled single item, ranging from 1 (not acceptable) to 5 (completely acceptable)
Demand for the intervention measured by the proportion of physicians who viewed the intervention
Time Frame: within 96 hours of signing study consent
Percentage of physicians who viewed intervention by email "read" receipts, range 0 to 100%
Fidelity to intervention measured by proportion of tip sheet phrases used by physicians
Time Frame: within 96 hours of signing study consent
Proportion of tip sheet phrases used in family meeting as determined by review of audio-recorded family meeting, range 0 to 100%
Practicality as measured by dropout rate from study
Time Frame: through study completion, up to 1 year
Dropout rate as ascertained by review of study logs, range 0 to 100%
Practicality as measured by time to complete physician or family surveys
Time Frame: within 96 hours of signing study consent
Time to complete physician or family surveys as measured by review of study logs, range 0 to 60 minutes
Secondary Outcomes
- Decisional conflict among families, measured by Decisional Conflict Scale(within 96 hours of signing study consent)
- Psychological distress among physicians, measured by moral distress scale(within 96 hours of signing study consent)
- Components of shared decision making, as measured by content analysis of family meeting recordings(through study completion, up to 1 year)
- ICU utilization among patients, as measured by length of stay(through study completion, up to 1 year)
- Decisional regret among families, measured by Decision Regret Scale(within 96 hours of signing study consent)
- Psychological distress among families, measured by Impact of Events Revised scale(within 96 hours of signing study consent)