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NCT05710744 | Recruiting | Health Care Disparities


Mitigating Racial Disparities in Shared Decision Making in the Intensive Care Unit
Sponsor:

Duke University

Brief Summary:

This is a non randomized pilot trial aimed to: Test the feasibility of an intervention to support intensive care unit clinicians in conducting shared decision making conversations with families of patients with acute respiratory failure. The goal of this intervention is to mitigate racial disparities in shared decision making.

Condition or disease

Health Care Disparities

Intervention/treatment

Shared decision making tip sheet

Phase

Not Applicable

Detailed Description:

The care of critically ill patients with acute respiratory failure involves life-or-death decisions. Ideally, intensive care unit (ICU) clinicians should include patients or their families in shared decision making, which promotes goal-concordant care (i.e., care aligned with patients' preferences), reduces psychological distress for both families and clinicians, and shortens ICU length of stay. However, racial disparities have been documented in shared decision making and associated outcomes. In outpatient settings, clinicians treat Black patients differently from White patients, providing fewer treatment options, less prognostic information, and less emotional support, and making assumptions about rather than eliciting patient preferences. Disparities in shared decision making are likely to be amplified in the ICU because clinicians often do not have long-standing relationships with patients or families, and decisions are complex, emotional, and time-pressured. Yet, no interventions currently exist to address racial disparities in shared decision making about acute respiratory failure. This research will directly fill this gap.}}

Study Type : Interventional
Estimated Enrollment : 150 participants
Masking : None (Open Label)
Primary Purpose : Health Services Research
Official Title : Mitigating Racial Disparities in Shared Decision Making in the Intensive Care Unit
Actual Study Start Date : July 7, 2023
Estimated Primary Completion Date : December 31, 2027
Estimated Study Completion Date : December 31, 2027
Arm Intervention/treatment

No Intervention: Family Members of patients in the ICU

Family members will join routine meetings with the physicians treating with their critically ill loved ones.

Other: ICU Physicians

Physicians will view a tip sheet containing information about best practices of shared decision making with diverse individuals. Physicians will then conduct routine meetings with families of patients with acute respiratory failure.

Ages Eligible for Study: 18 Years
Sexes Eligible for Study: All
Accepts Healthy Volunteers: Accepts Healthy Volunteers
Criteria
Physician inclusion criterion
  • - ICU attending physician with at least 6 weeks of clinical service time in the 12 months preceding and following enrollment
  • Physician exclusion criterion
    • - Board certified in palliative care medicine
    • Patient inclusion criteria
      • Admitted to the ICU
      • Being treated by a study physician currently and at least for the next 48 hours
      • ≥ 18 years of age upon admission to hospital
      • Mechanically ventilated ≥ 4 days
      • Patient exclusion criterion
        • Tracheostomy tube present or decision to pursue tracheostomy within next 7 days
        • Has decision making capacity as assessed by medical team
        • Extubation planned or death anticipated in next 24 hours
        • Patients who are prisoners or are pregnant
        • Awaiting organ transplantation during this hospitalization
        • Acute respiratory failure due to progression of chronic neuromuscular disease
        • No family decision maker available
        • Family member inclusion criteria
          • Identified by medical team as person most involved in medical decision making for the patient
          • Confirmed to be patient's legally authorized representative
          • Self-identifies as non-Hispanic, Black or White
          • ≥ 18 years of age at time of consent
          • Confirms conversational fluency in English

Mitigating Racial Disparities in Shared Decision Making in the Intensive Care Unit

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Mitigating Racial Disparities in Shared Decision Making in the Intensive Care Unit

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Locations


Recruiting

United States, North Carolina

Duke University Medical Center

Durham, North Carolina, United States, 27710

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