ADJUST: A Study on MDT Prognostication

Study Overview
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Brief Summary
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This study investigates how clinicians form intuitive judgements about the prognoses of palliative care patients after receiving advice perceived as coming from either a team member or an algorithm.

Detailed Description
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Using the Judge-Advisor System, the investigators will recruit clinicians working in palliative care for adults. Participants will be asked to complete an online survey and review five patient summaries (vignettes) based on real cases derived from a previous study. Clinicians will be presented with key prognostic information and will be asked to provide an estimate of the probability that the patient will survive for two weeks (0-100%). After providing this initial estimate, participants will receive prognostic advice. While in reality all participants will receive the same advice, participants will be randomised into two groups and these groups will be informed that the advice is either: (1) provided by an algorithm; or (2) provided by a team colleague. Participants will then be given the opportunity to give a second, possibly revised estimate in the light of the advice received.

Official Title
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Study of Advice and Decision-making on Prognosis Using the Judge-advisor System Within Multi-disciplinary Teams (ADJUST)

Conditions
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Terminal Illness

Intervention / Treatment
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* Other: Advice from the PiPS-B14 prognostic tool
* Other: Advice from another clinician


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinicians working in an adult palliative care service Willing and able to provide written informed consent Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants were randomly assigned to one of two study arms and received advice reportedly from either a prognostic algorithm, or another clinician.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Algorithm Arm<br>Participants received prognostic advice from a prognostic algorihm. | Other: Advice from the PiPS-B14 prognostic tool<br>* Participants were informed that prognostic advice came from the PiPS-B14 prognostic tool. PiPS-B14 is a validated prognostic algorithm that has been shown to be as accurate as an agreed multi-professional survival estimate. Participants were further informed that in a previous study the PiPS-B14 risk categories for predicting two-week survival were as accurate as a doctor's or a nurse's prediction.<br>|
| Experimental: Clinician arm<br>Participants recieved prognostic advice from another clinician. | Other: Advice from another clinician<br>* Participants were informed that prognostic advice came from another clinician. Doctors were told that advice was from a nurse, whereas nurses or other types of HCPs were told that advice was from a doctor.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Probability of survival estimate | Clinicians' estimates of the probability of a patient surviving for two weeks (0-100%) | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participants' weighting policies (characteristics of the participants) | Participants' responses to demographic questions | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | 
| Participants' weighting policies (the advice itself) | Strength of the prognostic advice provided by the advisor (0-100%) | Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prognostication, Multidisciplinary teams, Judge-Advisor System, Palliative Care, End-of-life