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

NCT02445937 | Completed DMC

• 1 other identifier: PRO14090204
• Study Type: interventional
• Target: 848
• Locations: 1 country
• Sites: 2

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. 1.To increase the patient-centeredness of end-of-life decisions, and to increase the quality of clinician-family communication.
2. 2.To decrease the psychological burden on family members acting as surrogates.
3. 3.To reduce total health care costs by decreasing the duration of use of burdensome, invasive treatments at the end of life.

Conditions

Anxiety; Depression

Keywords

decision making for incapacitated patients; intensive care; surrogate decision making; patient centered care; palliative care

Outcome Measures

Primary Outcomes (1)

• Quality of Communication (QOC) scale

  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.

  At 6 months

Secondary Outcomes (5)

• Hospital Anxiety and Depression Scale

  At 6 months

• Patient-Centeredness of Care Scale

  At 6 months

• Intensive Care Unit Length of Stay

  Participants will be followed for duration of ICU stay, an expected average of 21 days

• Impact of Events Scale

  At 6 months

• Decision Regret Scale

  At 6 months

Other Outcomes (5)

• Mortality

  At 6 months

• Katz Activities of Daily Living Scale

  At 6 months

• Hospital Length of Stay

  Participants will be followed for duration of hospital stay, an expected average of 4 weeks.

Study Arms (2)

Control

NO INTERVENTION

The control group will receive usual care, in which the frequency and content of physician-family communication is determined by the clinical team according to their usual practice. No study ICU has a protocolized approach to family communication and instead clinicians determine the timing and frequency of communication with families. All sites have palliative care services.

Behavioral: The PARTNER II Intervention

EXPERIMENTAL

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.

Behavioral: PARTNER II

Interventions

PARTNER II BEHAVIORAL

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.

Behavioral: The PARTNER II Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age or older
• Surrogate decision maker for ICU patient in one of 5 UPMC ICU's

You may not qualify if:

• Non-English Speaking
• Surrogate's loved one is for organ transplantation
• Not physically able to participate in family meeting

Sponsors & Collaborators

• University of Pittsburgh: lead

Study Sites (2)

UPMC Hamot

Erie, Pennsylvania, 16550, United States

Location

UPMC Presby/Shady

Pittsburgh, Pennsylvania, 15216, United States

Location

Related Publications (38)

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MeSH Terms

Conditions

Anxiety Disorders; Depression

Condition Hierarchy (Ancestors)

Mental Disorders; Behavioral Symptoms; Behavior

Study Officials

• Douglas B. White, MD, MAS

  University of Pittsburgh

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Vice Chair and Professor of Critical Care Medicine

Model Details: Stepped Wedge Design

Study Record Dates

• First Submitted: May 13, 2015
• First Posted: May 15, 2015
• Study Start: June 1, 2015
• Primary Completion: September 18, 2019
• Study Completion: September 18, 2019
• Last Updated: October 15, 2019

Record last verified: 2019-10

Locations

US (2)