Clinical trial NCT03360812: ORaClES: A Trial to Improve Prognostication
Official title: Online Randomised Controlled Trial to Improve Clinical Estimates of Survival (ORaClES)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Terminal Illness
Keywords: Medical Students
Education
Prognosis
Online training resource
Lead sponsor: University College, London
Sponsor class: OTHER
Collaborators: name: Brunel University
name: Imperial College London
name: Marie Curie Hospice, Belfast
name: Hull York Medical School
First posted: 2017-12-04
Enrollment: 170
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

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

Detailed description: 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.

Eligibility criteria: Inclusion Criteria:

1. Over 18 years of age
2. Enrolled on a registered medical course within the United Kingdom
3. In the penultimate or final year of medical school
4. Sufficient English language proficiency
5. Willing and able to provide consent as indicated by taking part in the online survey

Exclusion Criteria:

None

Primary outcomes:
measure: Survival estimates - immediate effect
timeFrame: 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 outcomes:
measure: Survival estimates - follow-up
timeFrame: 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.
measure: Cue weighting
timeFrame: 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.
measure: Level of expertise
timeFrame: 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.
Other outcomes:
Locations:
city: Brighton
country: United Kingdom
facility: Brighton and Sussex Medical School
city: Hull
country: United Kingdom
facility: Hull York Medical School
city: London
country: United Kingdom
facility: Imperial College London
city: London
country: United Kingdom
facility: St George's Medical School
city: London
country: United Kingdom
facility: UCL Medical School
Study officials:
affiliation: UCL
name: Patrick Stone, PhD, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Oostendorp L, White N, Harries P, Yardley S, Tomlinson C, Ricciardi F, Gokalp H, Stone P. Protocol for the ORaClES study: an online randomised controlled trial to improve clinical estimates of survival using a training resource for medical students. BMJ Open. 2019 Mar 3;9(3):e025265. doi: 10.1136/bmjopen-2018-025265.
citation: White N, Oostendorp LJ, Tomlinson C, Yardley S, Ricciardi F, Gokalp H, Minton O, Boland JW, Clark B, Harries P, Stone P. Online training improves medical students' ability to recognise when a person is dying: The ORaClES randomised controlled trial. Palliat Med. 2020 Jan;34(1):134-144. doi: 10.1177/0269216319880767. Epub 2019 Nov 14.