Please select the eligibility criteria that correspond 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: Inclusion Criteria: Physicians

* Currently in clinical practice at participating institutions
* Oncologist that cares for patients with solid tumors
* Not planning to leave the practice during the next 6 months

Inclusion Criteria: Patients

* Currently a patient of an enrolled physician
* Age 21 years or older
* Diagnosis of advanced cancer
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Inclusion Criteria: Caregivers

* Caregiver of a patient currently enrolled in the study
* Age 21 years or older
* Able to understand spoken English (study personnel will read materials to low literacy patients)

Exclusion Criteria: Physicians

* Non Physicians and physicians who are not oncologists
* Oncologists who exclusively care for patients with hematological malignancies
* Prior involvement in health-related coaching interventions

Exclusion Criteria: Patients

* Unable to complete orally-administered surveys in English
* Hospitalized or in hospice care at the time of recruitment
* Prior involvement in health-related coaching interventions
* Anticipating bone marrow transplantation or diagnosed with leukemia or lymphoma

Exclusion Criteria: Caregiver

Unable to complete orally-administered surveys in English
B: Inclusion Criteria:

* Diagnosis of dementia from Alzheimer's or other underlying cause
* Global Deterioration Scale (GDS) Stage 5, 6 or 7
* acute illness hospitalization

Exclusion Criteria:

* No English-speaking family decision-maker
* Primary physician expects study to be too stressful for family caregiver
C: Inclusion Criteria:

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

Exclusion Criteria:

* Non-English Speaking
* Surrogate's loved one is for organ transplantation
* Not physically able to participate in family meeting
D: DISEASE CHARACTERISTICS:

* Diagnosis of advanced cancer (stage IV disease) AND meets all of the following criteria:

  * Referred by participating physician
  * Must speak English
  * Receiving primary oncology care at participating centers, defined as at least 2 visits to the clinic during the past year and a future scheduled appointment
  * Receiving treatment for any malignancy
  * Has access to a telephone

PATIENT CHARACTERISTICS:

* Not specified

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics

Answer: C