N/A
N=255
A Communication Tool to Assist Severely Injured Older Adults
Communication
Bottom Line
View on ClinicalTrials.gov: NCT03188055 ↗Enrolled (actual)
255
Serious AEs
0.0%
Results posted
Dec 2020
Primary outcome: Primary: Family Member-reported Quality of End of Life Communication (QOC) Received From Study Surgeon — 6.6; 4.5 score on a scale — p=0.006
Study Design & Population
- Study type
- Interventional
- Phase
- N/A
- Interventions
- Best Case/Worst Case communication tool (Other)
- Age
- Adult, Older Adult · 50+ yrs
- Sex
- All
- Sponsor
- University of Wisconsin, Madison
- Primary completion
- Dec 2019
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Family Member-reported Quality of End of Life Communication (QOC) Received From Study Surgeon |
6.6; 4.5 | 0.006 sig |
| PRIMARY Family Member-reported General Communication (QOC) Received From Study Surgeon |
8.5; 8.3 | 0.709 |
| SECONDARY Nurse-reported Quality of End of Life Communication (QOC) Received From Study Surgeon |
6; 4.1 | 0.03 sig |
| SECONDARY Nurse-reported General Quality of Communication (QOC) Received From Study Surgeon |
7.7; 6.7 | 0.063 |
| SECONDARY Family-reported Communication and Care Coordination |
114.5; 113.8 | 0.892 |
| SECONDARY Family-reported Goal Concordant Care |
16; 15; 8; 7 | > . 99 |
| SECONDARY Patient-reported Trauma Quality of Life (TQoL) |
115.3; 126.7 | 0.188 |
| SECONDARY Family-reported Trauma Quality of Life (TQoL) |
102.6; 121.7 | 0.042 sig |
| SECONDARY Family-reported Care Quality and Bereavement |
— | — |
| SECONDARY Trauma Nurse-reported Moral Distress |
79.48; 82.56 | 0.698 |
| SECONDARY Trauma Physician-reported Moral Distress |
61.03; 51.42 | 0.15 |
Summary
The purpose of this study is to test the effect of the "Best Case/Worse Case" (BC/WC) communication tool on the quality of communication with older patients admitted to two trauma units. The intervention was developed and tested with acute care surgical patients at the University of Wisconsin (UW) and we are now testing whether the intervention will work in a different setting. We will test the intervention with severely injured older adults at Oregon Health Sciences University (OHSU) and Parkland Memorial Hospital (PMH) at the University of Texas Southwestern (UTS). In the first year, UTS/PMH and OHSU will recruit and enroll 50 patients in the control arm (total, for both sites) and train trauma surgeons to use the best case/worst case tool. In the second year, UTS/PMH and OHSU will recruit and enroll 50 patients in the intervention arm (total, for both sites). UW will compare survey-reported and chart-derived measures before and after clinicians learn to use the best case/worst case tool.
Eligibility Criteria
Patients
Inclusion Criteria
- Traumatically injured patients 50 and older admitted to the ICU
Exclusion Criteria
- Surgeons will have an opportunity to exclude a patient or family who, in the physician's judgment, would not be an appropriate participant
- Patients with a Physician Orders for Life-Sustaining Medical Treatment (POLST) or Medical Orders for Life-Sustaining Medical Treatment (MOLST) form on file in their medical record that specifies that the patient or their decision maker wishes them to receive no intervention
- Patients with an isolated head injury as defined by a Head Abbreviated Injury Scale (AIS) score of 2 or less and an External AIS score of 1 or 0 and a Glasgow Coma Scale (GCS) score of 15. This serves to exclude the mildly traumatically brain injured patients with minimal external injuries who require ICU-level monitoring for a short period of time only
Family Members
Inclusion Criteria
- N/A
Exclusion Criteria
- We will exclude patients whose family members do not speak English
- Under the age of 18
- Lack decision making capacity (DMC)
- Have a severe hearing or vision impairment.
Surgeons
Inclusion Criteria
-N/A
Exclusion Criteria
- Care providers who do not directly provide primary trauma care in the ICU
- Residents who have not had at least 5 years of postgraduate training
- Trauma consultants including for example, neurosurgeons, orthopedic surgeons, and otolaryngologists
Nurses
Inclusion Criteria
- The nurse responsible for care of the enrolled patient at 3 days post-admission will be invited to complete a Quality of Communication (QOC) survey assessment
Exclusion Criteria
- N/A
Data sourced from ClinicalTrials.gov (NCT03188055). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.