Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Improving Patient and Family Centered Care in Advanced Critical Illness
Brief Summary: One in five deaths in the U.S. occurs in or shortly after discharge from an intensive care unit (ICU), typically following decisions made by surrogate decision makers to forego life prolonging treatment. A large body of empirical research has identified deficiencies in care processes that contribute to three important problems: 1) family members often experience poor quality communication with ICU clinicians, leading to lasting psychological distress associated with the ICU experience; 2) patients near the end of life frequently receive invasive, expensive treatment that is inconsistent with their values and preferences, and 3) end-of-life care is a major contributor to health care costs.\[8, 9\] Although advance care planning can prevent some unwanted treatment, many patients wish for a trial of intensive treatment when the prognosis is uncertain, and therefore it seems likely that the need for interventions to improve "in-the-moment" decisions by surrogates will persist.\[10, 11\]

In a pilot project, the investigators developed the PARTNER intervention (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building), an interdisciplinary intervention that 1) gives new responsibilities and advanced communication skills training to existing ICU staff (local nurse leaders and social work members of the ICU team); 2) changes care "defaults" to ensure frequent clinician-family meetings; and 3) adds protocolized, nurse-administered coaching and emotional support of surrogates before and during clinician-family meetings. The objective of this proposal is to conduct a stepped wedge randomized controlled trial testing the PARTNER intervention in 5 ICUs among 1000 patients with advanced critical illness and their surrogates.


Options:
A: Arm Label: Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: Communication training and coaching | Arm Label: Control; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Communication training and coaching; Assigned to Arm(s): Intervention
B: Arm Label: Specialty Palliative Care; Type: EXPERIMENTAL; Interventions: Behavioral: Specialty Palliative Care | Arm Label: Control; Type: NO_INTERVENTION; Interventions: N/A | Intervention Type: BEHAVIORAL; Name: Specialty Palliative Care; Assigned to Arm(s): Specialty Palliative Care
C: Arm Label: ICU Usual Care Control; Type: ACTIVE_COMPARATOR; Interventions: Other: ICU Usual Care Control | Arm Label: The PARTNER Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: The PARTNER Intervention | Intervention Type: BEHAVIORAL; Name: The PARTNER Intervention; Assigned to Arm(s): The PARTNER Intervention | Intervention Type: OTHER; Name: ICU Usual Care Control; Assigned to Arm(s): ICU Usual Care Control
D: Arm Label: communication lecture; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: communication lecture | Arm Label: lecture plus CD-ROM; Type: EXPERIMENTAL; Interventions: Behavioral: lecture plus CD-ROM | Intervention Type: BEHAVIORAL; Name: communication lecture; Assigned to Arm(s): communication lecture | Intervention Type: BEHAVIORAL; Name: lecture plus CD-ROM; Assigned to Arm(s): lecture plus CD-ROM

Answer: C