Development of a Tailored Life-Sustaining Treatment Decision Support Intervention for Stroke Surrogate Decision Makers

NCT ID: NCT03427645

Last Updated: 2020-02-05

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

106 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-02-08

Study Completion Date

2019-11-22

Brief Summary

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The trial is testing an investigator-developed decision support tool for surrogate decision makers for stroke patients that are unable to make medical decisions for themselves.

A historical usual care control group will be enrolled during tool development. The tool will then be tested in surrogates of hospitalized stroke patients.

Detailed Description

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Decision support tools, specifically recommended in the 2010 Affordable Care Act, have been shown to improve the quality of decisions and reduce burden on the decision maker in multiple clinical settings, yet almost none have focused on life-sustaining treatments in acute critical illness such as stroke. This study proposes a comprehensive frame shift in how the health care team and surrogates collaborate on decisions regarding life-sustaining treatments for acute illness, by developing a tailored web-based stroke decision support intervention. This web-based tool will be developed for use by the surrogate decision maker during the acute stroke hospitalization and will be designed to facilitate high quality patient-centered decisions and minimize adverse effects on the surrogate.

The two project phases are: 1) Decision support intervention development; and 2) Pilot testing in surrogates of hospitalized stroke patients. A novel ordinal prognostic model will be developed and incorporated into the tool.

The project expects 25 surrogate-patient pairs in the control group, and 25 surrogate-patient pairs in the intervention group, which equals a total of 100 subjects.

Conditions

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Stroke

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Control Surrogate Arm

Usual care control group will complete baseline and follow-up questionnaires with standard decision making techniques. This group will not be asked to use the decision making tool.

Group Type NO_INTERVENTION

No interventions assigned to this group

Surrogate Decision Tool Arm

This group will complete a baseline questionnaire, then use the tool and complete follow up questionnaires.

Group Type EXPERIMENTAL

Decision tool

Intervention Type BEHAVIORAL

A tailored web-based stroke decision support intervention. This web-based tool will be developed for use by the surrogate decision maker during the acute stroke hospitalization and will be designed to facilitate high quality patient-centered decisions and minimize adverse effects on the surrogate.

Interventions

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Decision tool

A tailored web-based stroke decision support intervention. This web-based tool will be developed for use by the surrogate decision maker during the acute stroke hospitalization and will be designed to facilitate high quality patient-centered decisions and minimize adverse effects on the surrogate.

Intervention Type BEHAVIORAL

Other Intervention Names

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tailored decision support intervention

Eligibility Criteria

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Inclusion Criteria

* Self-identify as the surrogate decision maker for eligible patient
* Able to read and communicate in English without an interpreter
* Limited to one surrogate per patient


* Ischemic stroke or spontaneous intracerebral hemorrhage
* Impaired decisional capacity (per treating team)
* Enrolled on or before full hospital day 5
* Minimum illness severity (either):

* National Institutes of Health Stroke Scale ≥ 10
* Glasgow coma scale ≤12

Exclusion Criteria

* No prior relationship with patient
* Dementia or other cognitive or health condition that would impair their ability to participate

Patients:


* No surrogate available for study procedures
* Already on comfort measures only
* Physician refuses to allow approach for consent
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Nursing Research (NINR)

NIH

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role lead

Responsible Party

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Darin Zahuranec

Associate Professor of Neurology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Darin Zahuranec

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Locations

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The University of Michigan

Ann Arbor, Michigan, United States

Site Status

Countries

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United States

References

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Chen EP, Arslanian-Engoren C, Newhouse W, Egleston D, Sahgal S, Yande A, Fagerlin A, Zahuranec DB. Development and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makers. BMC Palliat Care. 2020 Jul 20;19(1):110. doi: 10.1186/s12904-020-00617-x.

Reference Type DERIVED
PMID: 32689982 (View on PubMed)

Other Identifiers

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1R21NR016332-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HUM00118298

Identifier Type: -

Identifier Source: org_study_id

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