Improving Partnerships With Family Members of ICU Patients

NCT ID: NCT02920086

Last Updated: 2019-09-09

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-05-09

Study Completion Date

2020-12-31

Brief Summary

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The purpose of this study is to improve the outcomes of critically ill older patients and the health outcomes of their families by capacitating and partnering with families in optimizing patient/family centered care.

Detailed Description

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There is a pressing need to improve the care of critically ill older patients. For critically ill patients who are frequently unable to participate in their own care and decision-making, partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families. However, the optimal means by which families engage in the role they play, and how best to capacitate them as advocates and partners in care while helping them maintain their own wellbeing, is not known.

The IMPACT trial will evaluate two interventions, each with a separate context, but similar in that they empower and support families; one focused on involvement in care, and the other focused on involvement in decision-making. The first is a nutrition intervention The OPTimal nutrition by Informing and Capacitating family members of best practices (OPTICs) intervention, a multi-faceted strategy to engage and empower family members to advocate for and audit best nutrition practices in their family members. The second is a decision support intervention. The REALISTIC-80 Decision Support Intervention, is a web-based tool (www.myicuguide.com) to support families in shared decision-making about goals of medical treatments.

The investigators propose to conduct a mixed methods multi-centre, open-label, randomized, clinical trial involving 3 groups (2 active interventions and a usual care group). The overall goal of this study is to demonstrate that the multi-faceted nutritional strategies that engage families in care of their family member tested in this trial will increase nutritional intake and optimize physical recovery in older critically ill patients at high nutrition risk.

Conditions

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Critical Illness

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Nutrition Education Program

Nutrition education for family members of an elderly critically ill patient

Group Type EXPERIMENTAL

Nutrition Education Program

Intervention Type BEHAVIORAL

* The OPTimal nutrition by Informing and Capacitating family members of best practices (OPTICS) intervention
* Nutritional education will be provided to ICU patents' families by a dietitian
* Tracking of nutritional information by family
* Encouragement for families to advocate for two or more Oral Nutritional Supplements per day for the patients (approximately 400 kcal/day)

Decision Support Program

Decision support education for family members of an elderly critically ill patient

Group Type EXPERIMENTAL

Decision Support Program

Intervention Type OTHER

* Families will be provided with a web-based decision support tool (My ICU Guide)
* Families will meet with the ICU medical team early in ICU stay to review goals of care

Usual Care

No intervention

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Nutrition Education Program

* The OPTimal nutrition by Informing and Capacitating family members of best practices (OPTICS) intervention
* Nutritional education will be provided to ICU patents' families by a dietitian
* Tracking of nutritional information by family
* Encouragement for families to advocate for two or more Oral Nutritional Supplements per day for the patients (approximately 400 kcal/day)

Intervention Type BEHAVIORAL

Decision Support Program

* Families will be provided with a web-based decision support tool (My ICU Guide)
* Families will meet with the ICU medical team early in ICU stay to review goals of care

Intervention Type OTHER

Other Intervention Names

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OPTICS The REALISTIC-80 Decision Support Intervention My ICU Guide

Eligibility Criteria

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Inclusion Criteria

1a) \> 60 years of age OR

1b) 55 years to 59 years old with one or more of the following diagnoses:

* Chronic obstructive lung disease - 2 of the 4 of: baseline PaCO2 of \> 45 torr, cor pulmonale; respiratory failure episode within the preceding year; forced expiratory volume in 1 sec \<0.5 L.
* Congestive heart failure - New York Heart Association class IV symptoms and left ventricular ejection fraction \< 25%.
* Cirrhosis - confirmed by imaging studies or documentation of esophageal varices and one of three conditions: a) hepatic coma, b) Child's class C liver disease, or c) Child's class B liver disease with gastrointestinal bleeding.
* Cancer - metastatic cancer or stage IV lymphoma.
* End-stage dementia (inability to perform all ADLs, mutism or minimal verbal output secondary to dementia, bed-bound state prior to acute illness) 2) Have a projected duration of ICU dependency of \>72 hours from time of final assessment. We define ICU dependency as the need for one or more of the following:
* Mechanical ventilation
* Non-invasive ventilation
* Renal replacement therapy
* Vasopressors or
* Artificial nutrition because of their underlying illness


* 18 years of age or older,
* present and expected to visit regularly (minimum about 3 times a week) while the patient is in hospital
* the nominated or legally appointed substitute decision-maker
* able to communicate in English (verbally and in writing).

Exclusion Criteria

* Patients who are not expected to remain alive in ICU for 72 hours after initial screening (physician judgment) or for whom life-sustaining treatments are expected to be withdrawn in the subsequent 72 hours (as sufficient time will be required for implementation of the study interventions)
* Uncomplicated elective surgical patients (regardless of age)
* Patients who have received organ transplantation during this hospitalization
Minimum Eligible Age

55 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Griffith University

OTHER

Sponsor Role collaborator

Clinical Evaluation Research Unit at Kingston General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Daren K. Heyland

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Daren Heyland, MD

Role: PRINCIPAL_INVESTIGATOR

Clinical Evaluation Research Unit

Locations

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Phoenix VA Medical Center

Phoenix, Arizona, United States

Site Status RECRUITING

Barnes Jewish Hospital/Washington University

St Louis, Missouri, United States

Site Status RECRUITING

Penn State Milton S. Hershey Medical Center

Hershey, Pennsylvania, United States

Site Status RECRUITING

Legacy Salmon Creek Medical Center

Vancouver, Washington, United States

Site Status RECRUITING

Medical College of Wisconsin

Milwaukee, Wisconsin, United States

Site Status RECRUITING

Gold Coast Health

Gold Coast, Queensland, Australia

Site Status RECRUITING

University of Calgary

Calgary, Alberta, Canada

Site Status WITHDRAWN

University of Ottawa

Ottawa, Ontario, Canada

Site Status RECRUITING

Sunnybrook Health Science Centre

Toronto, Ontario, Canada

Site Status RECRUITING

University Health Network

Toronto, Ontario, Canada

Site Status TERMINATED

Countries

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United States Australia Canada

Central Contacts

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Daren Heyland, MD

Role: CONTACT

613-549-6666 ext. 3339

Facility Contacts

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Mary Chew

Role: primary

Beth Taylor

Role: primary

Lauren Van Scoy

Role: primary

Joseph Jura, Dr

Role: primary

Jayshil Patel

Role: primary

Andrea Marshall

Role: primary

Kwadwo Kyeremanteng

Role: primary

Dominique Piquette

Role: primary

References

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Marshall AP, Van Scoy LJ, Chaboyer W, Chew M, Davidson J, Day AG, Martinez A, Patel J, Roberts S, Skrobik Y, Taylor B, Tobiano G, Heyland DK. A randomised controlled trial of a nutrition and a decision support intervention to enable partnerships with families of critically ill patients. J Clin Nurs. 2023 Sep;32(17-18):6723-6742. doi: 10.1111/jocn.16752. Epub 2023 May 9.

Reference Type DERIVED
PMID: 37161555 (View on PubMed)

Heyland DK, Davidson J, Skrobik Y, des Ordons AR, Van Scoy LJ, Day AG, Vandall-Walker V, Marshall AP. Improving partnerships with family members of ICU patients: study protocol for a randomized controlled trial. Trials. 2018 Jan 4;19(1):3. doi: 10.1186/s13063-017-2379-4.

Reference Type DERIVED
PMID: 29301555 (View on PubMed)

Other Identifiers

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IMPACT

Identifier Type: -

Identifier Source: org_study_id

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