ORaClES: A Trial to Improve Prognostication

Study Overview
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Brief Summary
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This study evaluates whether an online training resource can improve the performance of medical students in recognising imminently dying palliative care patients.

Detailed Description
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Clinicians are routinely asked to provide survival estimates for palliative care patients, but recognition of imminent death (last 72 hours of life) is often inaccurate. We developed an online training resource, based on a previous study that identified the symptoms or signs that were most influential in forming expert palliative care doctors' prognostic decisions about imminent death. This double-blind randomised controlled trial will evaluate the effectiveness of this online training resource in improving the performance of medical students in recognising imminently dying palliative care patients. Participants are asked to visit the study website and review three series of vignettes describing patients referred to palliative care. For each vignette, participants are asked to provide an estimate (0-100%) about the probability that the patient will die in the next 72 hours. After the first series of vignettes, students randomised to the intervention arm are given access to an online training resource showing how experts weighted the relative importance of symptoms and signs. All participants are asked to complete a second series of vignettes. After two weeks, all participants are asked to return to the website and complete a third series of vignettes to assess if any effect has been maintained.

Official Title
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Online Randomised Controlled Trial to Improve Clinical Estimates of Survival (ORaClES)

Conditions
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Terminal Illness

Intervention / Treatment
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* Other: Online training resource


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years of age Enrolled on a registered medical course within the United Kingdom In the penultimate or final year of medical school Sufficient English language proficiency Willing and able to provide consent as indicated by taking part in the online survey 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
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>The intervention is an online training resource to improve the recognition of imminent death in palliative care patients. The intervention should take approximately 15 minutes to complete. During this time, the participants who are in the intervention arm will be shown the results of a previous study which identified how expert palliative care doctors recognise imminently dying palliative care patients. The intervention will be implemented via the website, immediately after participants have completed the first set of vignettes. | Other: Online training resource<br>* Please see information included in the description of the intervention group.<br>|
| No Intervention: Control group<br>The participants assigned to the control group will not receive this additional information and will simply be informed that they are approximately half way through the task and will be asked to continue on to the next set of vignettes. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival estimates - immediate effect | The primary outcome will be a continuous survival estimate provided from the students for the second series of vignettes; ranging from 0-100%. | Second series of vignettes, taking into account the estimates from the first series. Students can participate at their convenience and will have a four week window to complete the first and second series of vignettes. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Survival estimates - follow-up | Survival estimates provided from the students at the two week follow-up; ranging from 0-100%. | Third series of vignettes, taking into account the estimates from previous series. Two weeks after completing the first and second series of vignettes, students will be asked to complete a third series of vignettes within a four week window. | 
| Cue weighting | Cue weighting of the individual students as compared to the experts; that is the coefficient of each factor as part of their judgement policy. | Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window. | 
| Level of expertise | The level of expertise will be assessed with the Cochran-Weiss-Shanteau (CWS) score. This score details the level of ability to discriminate and the level of consistency. | Change over time including all three series of vignettes. Students are given a four week window to complete the first and second series of vignettes. After two weeks, they will be asked to complete a third series of vignettes within a four week window. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medical Students, Education, Prognosis, Online training resource