- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01982877
The Four Supports Study: Family Support Intervention in Intensive Care Units
A Trial to Improve Surrogate Decision-Making for Critically Ill Older Adults
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
One in four elderly Americans die in or shortly after discharge from an intensive care unit. An expanding body of literature documents that physician-family communication and end-of-life care is poor in intensive care units. These deficiencies are associated with high rates of adverse psychological outcomes among surrogates, physician-family conflict, and life support decisions that may be inconsistent with patients' goals and preferences. There is a lack of information on practical, generalizable interventions that effectively improve this important aspect of care for elderly patients and their families.
The primary aim of this study is to evaluate the effectiveness of a multifaceted communication intervention as compared to an educational control to improve psychological outcomes among family members of critically ill patients, using a randomized, controlled trial design.
This randomized controlled trial involves adding a Family Support Specialist (FSS) to the clinical team to provide four types of support to the families of patients with advanced critical illness: emotional support, communication support (between the clinical team and the family), decisional support (education about the role of a surrogate decision maker) and anticipatory grief support.
The overall aim of the study is to improve the long-term psychological outcomes for family members of critically ill patients, to improve the quality of communication and decision-making between physicians and families, and to improve the patient-centeredness of care.
What happens in the study?
Patient is randomized to one of two groups:
- INTERVENTION GROUP: Family Support Specialist is added to the clinical team to provide emotional support to the family and facilitate frequent communication with the clinical team.
- CONTROL GROUP: Receives usual care with the addition of two educational sessions provided by the FSS to teach family members about the ICU environment.
What do participants need to do?
Family Members: Interact with the Family Support Specialist daily. Family Support Specialist addresses family needs and ensures that their questions are addressed.
Physicians: Collaborate with the Family Support Specialist to determine how best to support the family as well as attending clinician-family meetings.
Sample size: With a sample size of 300 patients (450 surrogates), the study is well powered to detect small and clinically important differences in the primary outcome measure Hospital Anxiety and Depression Score (HADS).The trial's original sample size of 400 patients (600 surrogates) was chosen to maximize the power to detect differences in a secondary outcome measure (costs) that required a substantially larger sample size than the primary outcome (HADS). Since the original power calculations were conducted, new data were published which indicated that cost analysis in this context will require an even larger sample size based one effect modification from whether the patient lived or died. Therefore, the Data and Safety Monitoring Board recommended revising the sample size to power the trial on the primary outcome (HADS), which required 300 patients (450 surrogates).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15216
- University of Pittsburgh
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Patient Inclusion criteria:
- age ≥21,
- lack of decision making capacity as determined by clinical examination by the attending physician,
- APACHE II score ≥ 22, AND/OR
- > 40% risk of death in hospital or >40% chance of severe long term functional impairment as judged by the patient's attending physician.
Patient Exclusion Criteria:
- lack of a surrogate decision maker and
- impending organ transplantation.
- decisions regarding care and treatment already made
- not currently participating in competing research study
- Discharged prior to enrollment
- Incarcerated.
Surrogate Inclusion criteria:
- age ≥ 18 years,
- self-identify as being involved in surrogate decision-making for the patient, up to a total of four family/surrogates.
- able to give full informed consent, and
- able to complete written questionnaires.
Surrogate Exclusion Criteria:
- age <18 years old,
- unable to read and understand English, and
- unable to complete questionnaires due to physical or cognitive limitations.
Physician Inclusion criteria:
1) Eligible physicians will be the patient's primary attending or his/her designee. If an enrolled patient is cared for by more than one attending physician during their ICU stay, each will be consented.
Physician Exclusion Criteria:
1) Study investigators will be excluded as participants.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Family Support Intervention
Multifaceted family support intervention as well as ICU educational component.
|
The Four Supports Intervention is a multi-faceted intervention involving the addition of a trained nurse/social worker interventionist to the patient's care team who delivers four kinds of support: emotional support, communication support, decision support, and anticipatory grief support.
In addition to usual care, enrolled surrogates will receive two 15-minute education sessions about critical illness and mechanical ventilation on days 2 and 5, delivered by a research staff coordinator with education in critical care nursing.
|
EXPERIMENTAL: Educational Control
ICU educational component
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In addition to usual care, enrolled surrogates will receive two 15-minute education sessions about critical illness and mechanical ventilation on days 2 and 5, delivered by a research staff coordinator with education in critical care nursing.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hospital Anxiety and Depression Scale
Time Frame: participants will be followed six months following the patient's death or discharge from hospital, an expected average of 195 days
|
Burden of anxiety and depression will be measured in family members 6 months after enrollment using the validated 14-item Hospital Anxiety and Depression scale (HADS).
|
participants will be followed six months following the patient's death or discharge from hospital, an expected average of 195 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient and family-centeredness of care
Time Frame: At 6 months
|
Patient and family-centeredness of care measured using the 12-item Patient-Perceived Patient-Centeredness of Care Scale (PPPC) adapted to use by surrogates.
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At 6 months
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Total Hospital Costs
Time Frame: Duration of hospital stay, an expected average of 4 weeks
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he costs are measured using aggregate data form the date of hospital admission through hospital discharge
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Duration of hospital stay, an expected average of 4 weeks
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Intensive Care Unit Length of Stay
Time Frame: Participants will be followed for duration of ICU stay, an expected average of 21 days
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The Intensive Care Unit length of stay , assessed by abstraction from hospital administrative records
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Participants will be followed for duration of ICU stay, an expected average of 21 days
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Hospital Length of stay
Time Frame: Participants will be followed for duration of hospital stay, an expected average of 4 weeks
|
Hospital length of stay length of stay , assessed by abstraction from hospital administrative records
|
Participants will be followed for duration of hospital stay, an expected average of 4 weeks
|
Impact of Events scale at 6 months
Time Frame: at 6 months
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Symptoms of post traumatic stress in family members assessed using the validated 22 item Impact of Events Scale.
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at 6 months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Concordance between clinicians and surrogates about patient's prognosis (CSCS)
Time Frame: Participants are followed at time of enrollment, on day 5 of enrollment, and weekly thereafter for the duration of the hospital stay, an expected average of 4 weeks
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Prognostic estimates of survival and long-term functional impairment are measured responses by assessing the surrogate decision maker and the physician
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Participants are followed at time of enrollment, on day 5 of enrollment, and weekly thereafter for the duration of the hospital stay, an expected average of 4 weeks
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Decisional Conflict Scale (DCS)
Time Frame: Participants are followed at time of enrollment and on day 5 of enrollment
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This validated instrument measures personal perceptions of:
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Participants are followed at time of enrollment and on day 5 of enrollment
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Quality of Communication Scale
Time Frame: Day 5 of enrollment
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Quality of communication in family members is assessed using the validated 19 item Quality of Communication Scale
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Day 5 of enrollment
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Impact of Events Scale
Time Frame: at 3 months
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Symptoms of post traumatic stress in family members assessed using the validated 22 item Impact of Events Scale.
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at 3 months
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Inventory of Complicated Grief
Time Frame: At 3 months and at 6 months
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This validated instrument consists of 19 first-person statements concerning the immediate bereavement-related thoughts and behaviors of the participant.
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At 3 months and at 6 months
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Utilization of Mental Health Treatment
Time Frame: At 3 months and 6 months
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The utilization of mental health treatment is tracked via participant interview
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At 3 months and 6 months
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Activity of Daily Living
Time Frame: At 6 months
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Functional status of the patient is assessed using the validated Katz Activities of Daily Living Scale.
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At 6 months
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Vital Status
Time Frame: At 6 months
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Mortality of the patient will be assessed at 6 months using hospital administrative records, and the 6-month follow-up with surrogate decision makers.
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At 6 months
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Discharge Dispensation
Time Frame: Participants will be followed for duration of hospital stay, an expected average of 4 weeks
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The disposition of the patient at time of discharge will be assessed via chart abstraction
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Participants will be followed for duration of hospital stay, an expected average of 4 weeks
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HADS
Time Frame: at 3 months
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Hospital Anxiety and Depression Scale
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at 3 months
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Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1R01AG045176-01 (NIH)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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