Navigation Links
Decision aid helps families, clinicians communicate about care decisions
Date:5/17/2011

ATS 2011, DENVER Surrogate decision-makers faced with the difficult task of overseeing loved ones' medical care may find help thanks to a new decision aid aimed at patients with prolonged mechanical ventilation. According to a study conducted by researchers in North Carolina, Pennsylvania and Washington who developed and tested the aid, surrogates reported the aid significantly improved the often daunting decision-making process.

The study results will be presented at the ATS 2011 International Conference in Denver.

The decision aid was developed specifically for surrogate decision makers of patients who require mechanical ventilation for extended periods, a condition known as prolonged mechanical ventilation (PMV). Each year, about 300,000 U.S. patients are placed on prolonged mechanical ventilation. About 50 percent of those patients die within a year, typically after spending 75 percent of their final days in health care facilities. These patients have healthcare costs exceeding $20 billion each year in the United States.

"For patients at risk for PMV, challenging decisions must be made about whether to continue a course of aggressive treatment or whether to emphasize comfort at the possible expense of survival," said study author Christopher Cox, MD, an assistant professor of medicine and co-director of the medical ICU at Duke University Medical Center. "The burden of life support decision-making rests on family members and other surrogate decision-makers because of patients' severe illnesses. However the quality of this decision-making process is severely deficient."

Dr. Cox said the communication deficit between clinicians and surrogates in the decision-making process has several causes, including difficulty explaining a complicated critical illness and its management options to surrogates, particularly in a multi-provider, shift-work environment.

"This poor communication quality leads to a dramatic degree of discordance between surrogates and clinicians for expected patient outcomes," Dr. Cox noted. "These deficiencies also may lead to decisions that are inconsistent with a patient's values, prolonged life support that is extraordinarily costly and ineffective, and psychological distress among surrogates."

Initially designed in a written format, the decision aid integrates clinical data, treatment goals and individualized prognostic estimates.

"The decision aid we developed was designed specifically for the surrogates of patients at risk of PMV to assist them in this complicated process," said Cox.

For their study, the researchers enrolled 30 surrogates of patients at risk for PMV who were being treated in medical and surgical ICUs at three North Carolina medical centers, and divided them into two groups: 20 surrogates who used the decision aid and 10 control surrogates who relied on usual care.

According to their results, surrogates who used the decision aid experienced greater improvements in the agreement between surrogates and both physicians and nurses about expected patient survival , decisional conflict, and both quality of communication and medical comprehension score, compared to controls. Those who used the decision aid also reported a 31 percent decrease in uncertainty about preferred treatment goals and were 44 percent more likely than controls to report that they engaged physicians in discussing long-term patient outcomes. Additionally, decision-aid patients had shorter hospital lengths of stay yet similar mortality to control patients.

"These data provide initial evidence that the PMV decision aid could help to improve surrogate-clinician decision-making quality and may reduce health care utilization," Dr. Cox said.

The results could have an important impact in ICUs around the world, he added.

"We hope that the decision aid can be used to complement, not replace, the physician-family interaction - and in this age of digital information, empower surrogates by providing them with useful information to make better decisions," he said.

Since the initial study involved a small sample of patients and was confined to two medical centers, Dr. Cox said future studies will need to involve larger patient populations and more medical centers to confirm the results.

Additional studies are under way to test both web-based and iPad-based versions of the decision aid, he said.

"We hope these digital versions will allow the decision aid to be widely disseminated to other providers worldwide," Dr. Cox said. "The potential target audience is both large and deserving."


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. Doctors decisions on initial hospital admissions may affect readmission rates
2. Altruistic decision making focus of NIDAs Addiction Science Award
3. FDA could analyze public health consequences of its decisions better
4. Too Much Information? Risk-benefit data does not always lead to informed decision-making
5. Poorly presented risk statistics could misinform health decisions
6. Sleep Deprivation May Encourage Risky Decisions
7. New report helps inform decisions about how science should be funded
8. Medical Surrogates May Pay Emotional Price for Crisis Decisions
9. When the doctor is a woman, patients expect them to be involved in decision making
10. Pitt study: End-of-life decisions take longer if patient hasnt shared wishes with family
11. Health-care systems not using best evidence in decision-making
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/27/2016)... Aliso Viejo, California (PRWEB) , ... June 27, 2016 , ... ... that are fully customizable inside of Final Cut Pro X," said Christina Austin - ... with another unique style. Final Cut Pro X users can now reveal ...
(Date:6/27/2016)... ... June 27, 2016 , ... ... its strategic partnership with Connance, a healthcare industry leader providing predictive analytics ... proprietary technology combine to provide health systems, hospitals and ambulatory surgical centers ...
(Date:6/27/2016)... ... June 27, 2016 , ... TopConsumerReviews.com recently awarded their highest five-star rating ... Millions of individuals in the United States and Canada wear eyeglasses. Once considered to ... correct vision and make a fashion statement. Even celebrities use glasses as a way ...
(Date:6/26/2016)... Battle Creek, Michigan (PRWEB) , ... June 26, 2016 , ... ... abuse, joined as sponsor of the 2016 Cereal Festival and World’s Longest Breakfast Table ... held in honor of the city’s history as home to some of the world’s ...
(Date:6/26/2016)... ... June 26, 2016 , ... PawPaws brand pet supplements owned ... developed to enhance the health of felines. The formula is all-natural and is made ... in the PawPaws Cat Kidney Support Supplement Soft Chews are Astragalus Root ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... , June 23, 2016 ... CAPR ), a biotechnology company focused on the ... announced that patient enrollment in its ongoing randomized ... has exceeded 50% of its 24-patient target. Capricor ... the third quarter of 2016, and to report ...
(Date:6/23/2016)... 23, 2016 Bracket , a leading clinical ... generation clinical outcomes platform, Bracket eCOA (SM) 6.0, at ... 26 – 30, 2016 in Philadelphia , ... Outcome Assessment product of its kind to fully integrate with ... Bracket eCOA 6.0 is a flexible platform for electronic clinical ...
(Date:6/23/2016)... INDIANAPOLIS , June 23, 2016 ... Tomorrow,s Leaders Scholarship is any indication, the future is ... online at www.diabetesscholars.org by the Diabetes Scholars ... in the way of academic and community service excellence. ... program since 2012, and continues to advocate for people ...
Breaking Medicine Technology: