Effect of Intensivist Communication on Surrogate Prognosis Interpretation

Study Overview
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Brief Summary
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This study evaluates the effect of physician communication styles on the interpretation of prognosis by family members of chronically-ill patients. Participants were randomized to view one of four videos how depicting different physicians disclose prognosis when physicians expect an ICU patient to die.

Detailed Description
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Intensivist-surrogate discordance about prognosis is common in the intensive care unit. Minimizing discordance and empowering families to make informed decisions about participants' loved one's care is important, but it is unclear how best to communicate prognostic information to vulnerable surrogates when a patient is expected to die. Participants are randomized to view one of 4 intensivist communication styles in response to the question What do you think is most likely to happen?: 1) a direct response (control), 2) an indirect response comparing the patient's condition to other patients, 3) an indirect response describing physiology, or 4) redirection to a discussion of patient values and goals. The participant will then be asked a series of questions to measure participants' interpretation of what the intensivist says.

Official Title
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The Effect of Intensivist Communication on Prognosis Interpretation by Family Members of Patients at High Risk for Intensive Care Unit Admission: A Randomized Trial

Conditions
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Critical Illness

Intervention / Treatment
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* Behavioral: Indirect - other patients
* Behavioral: Indirect - physiology
* Behavioral: Redirection
* Behavioral: Direct communication


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: spouse/partner, sibling, or adult child of a patient with Chronic Obstructive Pulmonary Disease (COPD) on home oxygen over age 18 Exclusion Criteria: ever working in healthcare as a nurse, advanced practice provider, or physician

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 are randomized in a 1:1:1:1 ratio to view a video depicting one of four different ways intensivists answered a patient surrogate's prognostic question What do you think is most likely to happen? during a simulated ICU family meeting.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Direct Communication (control)<br>A direct response where the intensivist acknowledges that he is not certain but believes the patient will not survive hospitalization. | Behavioral: Direct communication<br>* Video of a direct response.<br>|
| Active Comparator: Indirect - other patients<br>An indirect response describing the prognosis of other people similar to the patient in question. | Behavioral: Indirect - other patients<br>* Video depicting an indirect response focusing on a comparison to other patients.<br>|
| Active Comparator: Indirect - physiology<br>An indirect response describing the severe physiologic abnormalities present in the patient and potential future problems. | Behavioral: Indirect - physiology<br>* Video of an indirect response focusing on the physiology of the patient.<br>|
| Active Comparator: Redirection<br>Redirection to a conversation about the values of the patient and possible future decisions. | Behavioral: Redirection<br>* Video of a redirection towards discussing the patient's values and possible future decisions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant perception of the intensivist's prognostic estimate. | Participant response to the question If you had to guess, what do you think the doctor thinks is the chance that your loved one will survive this hospitalization? answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive. | approximately 5 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Participant prognostic estimate. | Participant response to the question What do you think are the chances that your loved one will survive this hospitalization? answered on a 0-100% percentage scale. 0% signifies no chance of survival and 100% signifies definitely will survive. | approximately 5 minutes | 
| Participant difference in belief about prognosis. | This is the difference between outcome #2 (participant prognostic estimate) and outcome #1 (participant perception of the intensivist's prognostic estimate), expressed as a difference in percentage. In other words, if for a given participant outcome #2 was a 50% chance of survival and outcome #1 was a 30% chance of survival then outcome #3 (participant difference in belief about prognosis) would be 50% - 30% = 20%. | approximately 5 minutes |