Proactive Ethics Intervention to Improve Intensive Care Unit (ICU) Care

NCT ID: NCT00996814

Last Updated: 2012-01-11

Study Results

Results pending

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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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

386 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-10-31

Study Completion Date

2010-02-28

Brief Summary

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The primary aim of the study is to demonstrate the value of a preemptive approach to ethics consultation in an ICU. The investigators hope to answer the question: Will proactive ethics interventions by a skilled and experienced ethicist, participating in treatment discussions with physicians and nurses, as well as discussions with patients/surrogates, improve the quality of ICU care experienced by patients requiring prolonged treatment in the ICU (5 days or longer) by increasing their perceived quality of care and reducing the length of stay in the ICU by non-survivors?

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.

Detailed Description

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Conditions

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Intensive Care Unit Days

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

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

Group Type EXPERIMENTAL

Proactive Ethics Intervention

Intervention Type BEHAVIORAL

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.

Group Type NO_INTERVENTION

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.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Adult (over 18 years of age)
* Under treatment for five days or more in the ICU

Exclusion Criteria

* Under the age of 18
* Non-English Speaking
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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California Pacific Medical Center Research Institute

OTHER

Sponsor Role lead

Responsible Party

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James (Wes) McGaughey

Research Analyst

Responsibility Role PRINCIPAL_INVESTIGATOR

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

Site Status

Countries

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United States

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.

Reference Type DERIVED
PMID: 24201177 (View on PubMed)

Other Identifiers

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26.111EXP

Identifier Type: -

Identifier Source: org_study_id

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