Effect of Intensivist Communication on Surrogate Prognosis Interpretation
- Conditions
- Critical Illness
- Interventions
- Behavioral: Direct communicationBehavioral: RedirectionBehavioral: Indirect - other patientsBehavioral: Indirect - physiology
- Registration Number
- NCT04239209
- Lead Sponsor
- Johns Hopkins University
- Brief Summary
This study evaluates the effect of physician communication styles on the interpretation of prognosis by family members of chronically-ill patients. Participants were randomized to view one of four videos how depicting different physicians disclose prognosis when physicians expect an ICU patient to die.
- Detailed Description
Intensivist-surrogate discordance about prognosis is common in the intensive care unit. Minimizing discordance and empowering families to make informed decisions about participants' loved one's care is important, but it is unclear how best to communicate prognostic information to vulnerable surrogates when a patient is expected to die. Participants are randomized to view one of 4 intensivist communication styles in response to the question "What do you think is most likely to happen?": 1) a direct response (control), 2) an indirect response comparing the patient's condition to other patients, 3) an indirect response describing physiology, or 4) redirection to a discussion of patient values and goals.
The participant will then be asked a series of questions to measure participants' interpretation of what the intensivist says.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 302
- spouse/partner, sibling, or adult child of a patient with Chronic Obstructive Pulmonary Disease (COPD) on home oxygen
- over age 18
- ever working in healthcare as a nurse, advanced practice provider, or physician
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Direct Communication (control) Direct communication A direct response where the intensivist acknowledges that he is not certain but believes the patient will not survive hospitalization. Redirection Redirection Redirection to a conversation about the values of the patient and possible future decisions. Indirect - other patients Indirect - other patients An indirect response describing the prognosis of other people similar to the patient in question. Indirect - physiology Indirect - physiology An indirect response describing the severe physiologic abnormalities present in the patient and potential future problems.
- Primary Outcome Measures
Name Time Method Participant perception of the intensivist's prognostic estimate. approximately 5 minutes Participant response to the question "If you had to guess, what do you think the doctor thinks is the chance that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.
- Secondary Outcome Measures
Name Time Method Participant prognostic estimate. approximately 5 minutes Participant response to the question "What do you think are the chances that your loved one will survive this hospitalization?" answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive.
Participant difference in belief about prognosis. approximately 5 minutes This is the difference between outcome #2 (participant prognostic estimate) and outcome #1 (participant perception of the intensivist's prognostic estimate), expressed as a difference in percentage. In other words, if for a given participant outcome #2 was a 50% chance of survival and outcome #1 was a 30% chance of survival then outcome #3 (participant difference in belief about prognosis) would be 50% - 30% = 20%.
Trial Locations
- Locations (1)
Johns Hopkins University
🇺🇸Baltimore, Maryland, United States