Proactive Ethics Intervention to Improve Intensive Care Unit (ICU) Care
NCT ID: NCT00996814
Last Updated: 2012-01-11
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
386 participants
INTERVENTIONAL
2007-10-31
2010-02-28
Brief Summary
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The study is a randomized trial of the use of an ethics consultant to address latent or manifest ethical issues in patients who remain in the ICU for five days or more, as compared to usual care. The investigators are testing the hypothesis that expanding the role of ethics consultations in the ICU to make them proactive will improve the process and outcomes of patient care by shortening the length of stay in non-survivors, and reducing suffering and unwanted and/or unnecessary aggressive treatments.
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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Proactive Ethics Intervention
These patients have an ethics consultant involved in their care beginning on the fifth day of treatment in the ICU
Proactive Ethics Intervention
The ethicist will: 1) meet with the patient or surrogate to assess the case and the decision-making capacity of the patient; 2) make an ethical diagnosis, framing the issues in easily understood ethical terms with the involved parties; 3) recommend the next steps, including measures to improve communication. The ethicist will help to articulate consensus or disagreement and either facilitate implementing the consensus or facilitate ways to address and resolve disagreements; 4) document the consultation in the patient's medical record, identifying the ethical issues identified, the steps taken to address those issues, the options and ethical rationales considered, the outcome and the future plan; 5) follow-up to provide ongoing support and record a follow up progress note in the chart; and 6) participate in evaluation.
Usual Care
These patients receive usual care in the ICU.
No interventions assigned to this group
Interventions
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Proactive Ethics Intervention
The ethicist will: 1) meet with the patient or surrogate to assess the case and the decision-making capacity of the patient; 2) make an ethical diagnosis, framing the issues in easily understood ethical terms with the involved parties; 3) recommend the next steps, including measures to improve communication. The ethicist will help to articulate consensus or disagreement and either facilitate implementing the consensus or facilitate ways to address and resolve disagreements; 4) document the consultation in the patient's medical record, identifying the ethical issues identified, the steps taken to address those issues, the options and ethical rationales considered, the outcome and the future plan; 5) follow-up to provide ongoing support and record a follow up progress note in the chart; and 6) participate in evaluation.
Eligibility Criteria
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Inclusion Criteria
* Under treatment for five days or more in the ICU
Exclusion Criteria
* Non-English Speaking
18 Years
ALL
No
Sponsors
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California Pacific Medical Center Research Institute
OTHER
Responsible Party
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James (Wes) McGaughey
Research Analyst
Principal Investigators
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William S Andereck, MD
Role: PRINCIPAL_INVESTIGATOR
California Pacific Medical Center
Lawrence J Schneiderman, MD
Role: PRINCIPAL_INVESTIGATOR
University of California, San Diego
J. Westly McGaughey, B.A.
Role: PRINCIPAL_INVESTIGATOR
California Pacific Medical Center
Albert R. Jonsen, Ph.D.
Role: PRINCIPAL_INVESTIGATOR
California Pacific Medical Center
Locations
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California Pacific Medical Center
San Francisco, California, United States
Countries
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References
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Andereck WS, McGaughey JW, Schneiderman LJ, Jonsen AR. Seeking to reduce nonbeneficial treatment in the ICU: an exploratory trial of proactive ethics intervention*. Crit Care Med. 2014 Apr;42(4):824-30. doi: 10.1097/CCM.0000000000000034.
Other Identifiers
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26.111EXP
Identifier Type: -
Identifier Source: org_study_id
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