ICU Communication Tool for Serious Injury

Not currently recruiting at 7 trial locations

Overseen By Kyle J Bushaw, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

Disqualifiers: None

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: During ICU stay (3 or more days)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests the Best Case/Worst Case-ICU Communication Tool, designed to improve conversations in the ICU for older adults with serious injuries. The study examines how this tool can enhance communication quality, reduce clinician stress, and potentially shorten ICU stays. Participants include patients aged 50 and older who have been in the ICU for at least three days due to major injuries. Family members involved in decision-making and clinicians working in the ICU also participate. As an unphased trial, this study allows participants to contribute to improving ICU communication and patient care.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that the Best Case/Worst Case-ICU communication tool is safe for use in the ICU?

Research has shown that the Best Case/Worst Case-ICU communication tool improves conversations between healthcare providers and patients or their families in the ICU. This tool clarifies care decisions by illustrating different possible outcomes, such as the best and worst scenarios.

In terms of safety, this communication tool is neither a drug nor a medical procedure, so it poses no risks like side effects or physical harm. It enhances discussions between doctors and families about treatment options. Studies have demonstrated that it helps align decisions with a patient's wishes, leading to greater satisfaction for both families and healthcare providers.

For those considering joining a trial using this tool, it is reassuring to know that it is well-received and aims to enhance the care experience during a challenging time. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the ICU Communication Tool for Serious Injury because it offers a more holistic approach to patient care. Unlike the standard of care, which often focuses on treating isolated problems without considering the patient's overall health trajectory, this tool encourages daily scenario planning. It helps healthcare providers discuss the best and worst case scenarios with patients, aligning treatments with patient preferences and improving decision-making. This can lead to more personalized care and potentially better outcomes by ensuring that medical interventions are in sync with what patients value most.

What evidence suggests that the Best Case/Worst Case-ICU communication tool is effective for improving communication and reducing clinician moral distress in the ICU?

Research has shown that the Best Case/Worst Case-ICU communication tool, which participants in this trial may experience, improves conversations about patient care in trauma ICUs. Studies indicate that this tool facilitates discussions between doctors and families about potential patient outcomes, helping everyone understand the best and worst possible scenarios. This approach supports clearer communication and may reduce stress for both doctors and families. Early findings suggest it also aids in planning care that aligns with the preferences of patients and families. While the tool aims to enhance communication, its impact on patient ICU stay duration and clinician stress remains under investigation. ^{1 2 3 6 7}

Who Is on the Research Team?

Margaret L Schwarze, MD, MPP

Principal Investigator

University of Wisconsin, Madison

Are You a Good Fit for This Trial?

This trial is for older adults aged 50 or above who have been seriously injured and are staying in the ICU for at least three days. It's not specified, but typically people with certain medical conditions or treatments that could interfere with the study may be excluded.

Inclusion Criteria

Clinicians who provide care in the trauma ICU (including attending trauma surgeons, fellows, residents, advance practice providers, bedside nurses and medical assistants, respiratory techs and physical therapists, social workers, and chaplains)

I am 50 or older and was in the ICU for 3+ days after a serious injury.

Exclusion Criteria

My family member cannot make their own health decisions.

Clinicians who do not provide care in the trauma ICU

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention Implementation

Training of trauma surgeons, trainees, and ICU clinicians to use the Best Case/Worst Case-ICU communication tool

3 months

Training sessions at each site

Treatment

Participants receive care from a trauma team using the Best Case/Worst Case-ICU communication tool

During ICU stay (3 or more days)

Follow-up

Participants are monitored for outcomes such as ICU length of stay, quality of communication, and clinician moral distress

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Best Case/Worst Case-ICU Communication Tool

Trial Overview The study is testing a communication tool called Best Case/Worst Case-ICU to see if it improves how doctors talk about care, reduces stress on clinicians, and possibly shortens ICU stays. The trial will involve patients from multiple hospitals across the country.

How Is the Trial Designed?

Group I: Best Case/Worst Case-ICU Communication Tool Experimental Treatment 1 Intervention

Patients in the intervention group will receive care from a trauma team that routinely uses the Best Case/Worst Case-ICU communication tool.

Group II: Usual Care Active Control 1 Intervention

Prior to implementation of the intervention, patients admitted to the trauma ICU will receive usual care. Usual care typically includes conversations focused on isolated problems, disarticulated from the patient's overall health trajectory. This is typified by the systems-base review, routinely summarizing each patient on rounds where the clinician lists each physiologic system, (e.g., neuro, cardiac, pulmonary…) with an assessment and plan to "fix" each abnormality with a new treatment. Deliberation about how these individual treatments align with patient preferences is typically prompted by major events like failure to liberate from a ventilator or imminent death. This pattern of usual care is well characterized and differs from daily scenario planning with the Best Case/Worst Case-ICU communication tool.

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Lehigh Valley Health Network

Collaborator

University of Maryland, Baltimore

Collaborator

Trials

729

Recruited

540,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Shock Trauma - University of Maryland Medical Center

Collaborator

Trials

1

Recruited

7,600+

University of California, Davis

Collaborator

Trials

958

Recruited

4,816,000+

Harborview Injury Prevention and Research Center

Collaborator

Trials

12

Recruited

14,500+

Lehigh Valley Health Network

Collaborator

Trials

4

Recruited

8,100+

Grady Memorial Hospital

Collaborator

Trials

5

Recruited

8,500+

Froedtert Hospital

Collaborator

Trials

10

Recruited

10,700+

Citations

1. jamanetwork.com jamanetwork.com/journals/jamasurgery/fullarticle/2839140

Best Case/Worst Case Communication Tool for Trauma ICUs This quality improvement study implements a tool supporting prognostic communication in 8 trauma intensive care units and assesses the reach ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12461598/

Best Case/Worst Case Communication Tool for Trauma ... This quality improvement study implements a tool supporting prognostic communication in 8 trauma intensive care units and assesses the reach ...

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40991261/

Best Case/Worst Case Communication Tool for Trauma ... This study found that implementation of BC/WC-ICU in trauma ICUs is feasible, supports prognostic communication, and can improve the ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0885392425001149

Clinician Experiences Using the Best Case/worst Case Best Case/Worst Case-ICU (BC/WC-ICU) uses scenario planning to communicate prognosis for older adults with serious injury. Preliminary studies show measurable ...

5. bmjopen.bmj.com bmjopen.bmj.com/content/14/8/e083603

Best Case/Worst Case-ICU: protocol for a multisite ... We designed the Best Case/Worst Case-ICU tool to help visualise uncertainty, illustrate the interplay between major events and prognosis and describe how ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8939782/

Best Case/Worst Case for the Trauma ICU “Best Case/Worst Case” (BC/WC) is a communication tool to support shared decision making in older adults with surgical illness.

7. patientpreferences.org patientpreferences.org/bcwc-icu/

Best Case/Worst Case: ICU These Best Case/Worst Case training materials are intended for use by (1) physicians who care for patients admitted to the ICU after serious injury and (2) ...