Intensive Communication for Chronically Critically Ill
This study was a trial of a formal system of family meetings to support family decision makers of chronically critically ill patients in the intensive care unit.
|Study Design:||Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Supportive Care
|Official Title:||Intensive Communication for Chronically Critically Ill|
- length of stay and depression [ Time Frame: ICU admission, Day 5, discharge, and 2 months ] [ Designated as safety issue: No ]
|Study Start Date:||November 2005|
|Study Completion Date:||May 2008|
|Primary Completion Date:||April 2008 (Final data collection date for primary outcome measure)|
No Intervention: Control usual care
usual care and communication
Other: Intensive Communication System
Regular family meetings once a week, using a standard protocol
Other Name: Intervention arm
Formal family meetings have been recommended as a useful approach to assist in goal setting, facilitate decision making, and reduce use of ineffective resources in the ICU. We implemented an "intensive communication system" to test the effect of regular, structured formal family meetings on patient outcomes among long-stay ICU patients
The design was a pre-post, tandem assignment of patients (n=217) receiving usual care and communication, followed by enrollment of intervention patients (n=354), from 5 ICUs. The "intensive communication system" included: (1) family meeting within 5 days of ICU admission and weekly thereafter; (2) each meeting addressed medical update, values and preferences, goals of care; treatment plan, and milestones for judging effectiveness of treatment.
We measured differences between control and intervention patients in indicators of aggressiveness of care or timing of treatment limitation decisions (ICU mortality, LOS, duration of ventilation, treatment limitation orders, or use of tracheostomy or percutaneous gastrostomy). Difference in outcomes among patients who died or who had treatment limitation orders, comparing control and intervention groups, was also examined.
|United States, Ohio|
|University Hosptials Case Medical center|
|Cleveland, Ohio, United States, 44106|
|Principal Investigator:||Barbara J Daly, PhD, RN||Case Western Reserve University|