ADJUST: A Study on MDT Prognostication (ADJUST)

Study of Advice and Decision-making on Prognosis Using the Judge-advisor System Within Multi-disciplinary Teams (ADJUST)

This study investigates how clinicians form intuitive judgements about the prognoses of palliative care patients after receiving advice perceived as coming from either a team member or an algorithm.

Study Overview

• Status: Completed
• Conditions: Terminal Illness
• Intervention / Treatment: Other: Advice from the PiPS-B14 prognostic tool; Other: Advice from another clinician

Detailed Description

Using the Judge-Advisor System, the investigators will recruit clinicians working in palliative care for adults. Participants will be asked to complete an online survey and review five patient summaries ("vignettes") based on real cases derived from a previous study. Clinicians will be presented with key prognostic information and will be asked to provide an estimate of the probability that the patient will survive for two weeks (0-100%). After providing this initial estimate, participants will receive prognostic advice. While in reality all participants will receive the same advice, participants will be randomised into two groups and these groups will be informed that the advice is either: (1) provided by an algorithm; or (2) provided by a team colleague. Participants will then be given the opportunity to give a second, possibly revised estimate in the light of the advice received.

• Study Type: Interventional
• Enrollment (Actual): 323
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, WC1E 6BT
    • University College London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinicians working in an adult palliative care service
• Willing and able to provide written informed consent

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Algorithm Arm; Participants received prognostic advice from a prognostic algorihm.	Other: Advice from the PiPS-B14 prognostic tool; Participants were informed that prognostic advice came from the PiPS-B14 prognostic tool. PiPS-B14 is a validated prognostic algorithm that has been shown to be as accurate as an agreed multi-professional survival estimate. Participants were further informed that in a previous study the PiPS-B14 risk categories for predicting two-week survival were as accurate as a doctor's or a nurse's prediction.
Experimental: Clinician arm; Participants recieved prognostic advice from another clinician.	Other: Advice from another clinician; Participants were informed that prognostic advice came from another clinician. Doctors were told that advice was from a nurse, whereas nurses or other types of HCPs were told that advice was from a doctor.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probability of survival estimate	Clinicians' estimates of the probability of a patient surviving for two weeks (0-100%)	Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participants' weighting policies (characteristics of the participants)	Participants' responses to demographic questions	Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette
Participants' weighting policies (the advice itself)	Strength of the prognostic advice provided by the advisor (0-100%)	Participants will have up to 7 months (until the study closes) to provide an estimate for each vignette

Collaborators and Investigators

• Sponsor: University College, London
• Investigators: Principal Investigator: Patrick Stone, MA MD FRCP, UCL (University College London)

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2020
• Primary Completion (Actual): April 13, 2021
• Study Completion (Actual): April 13, 2021

Study Registration Dates

• First Submitted: September 23, 2020
• First Submitted That Met QC Criteria: September 23, 2020
• First Posted (Actual): September 29, 2020

Study Record Updates

• Last Update Posted (Actual): January 10, 2022
• Last Update Submitted That Met QC Criteria: December 16, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Palliative Care; End-of-life; Prognostication; Multidisciplinary teams; Judge-Advisor System
• Other Study ID Numbers: 17031/001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data (suitably anonymised) may be shared with other research groups if a reasonable request is submitted to and agreed by the CI
• IPD Sharing Time Frame: The data will become available after the publication of results and will be archived securely by the Chief Investigator for a minimum of 20 years from the declaration of end of study
• IPD Sharing Access Criteria: The data will be shared upon reasonable request
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No