Communicating About Time-Limited Trials

Downer, Kendall; Gustin, Jillian; Lincoln, Taylor; Goodman, Lauren; Barnett, Matthew

doi:10.1016/j.chest.2021.08.071

Cited by 12 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of registered treatment limitation decisions in older patients with concordant perceptions of excessive care reached 30% gradually over time; indicating that most ICU clinicians agree on offering older patients an ICU trial that lasts long enough to observe possible improvements, or to reach consensus among family members and clinicians. 30,31 A similar percentage of treatment limitation decisions in older persons was found in the recent multi-center VIP-1and 2 studies. 23,32 However, a 30% incidence of treatment limitation decisions does not reflect the poor outcomes of the identified patients.…”

Section: J O U R N a L P R E -P R O O Fsupporting

confidence: 67%

Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses

Piers

Banner‐Goodspeed

Åkerman

et al. 2023

CHEST

View full text Add to dashboard Cite

Section: J O U R N a L P R E -P R O O Fsupporting

confidence: 67%

Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses

Piers

Banner‐Goodspeed

Åkerman

et al. 2023

CHEST

View full text Add to dashboard Cite

“…In einer Behandlungssituation, die nahezu aussichtslos ist, werden Therapieoptionen mit konkreten Erfolgskriterien und festgelegter Dauer vereinbart, die dem gegenwärtigen Therapieziel der Patientin oder des Patienten entsprechen [ 7 , 8 ]. Bereits festgelegte Vereinbarungen zur Therapielimitierung werden beibehalten oder erweitert, wenn dies angezeigt ist.…”

Section: Durchführungunclassified

Time-limited trials (TLT) in the intensive care unit

Jöbges,

Seidlein,

Knochel

et al. 2024

Med Klin Intensivmed Notfmed

View full text Add to dashboard Cite

ZusammenfassungDie Zunahme der intensivmedizinischen Behandlungsverfahren ist mit einer Steigerung der Komplexität der Entscheidungen über Auswahl, Anwendung und Dauer der Therapiemaßnahmen verbunden. Ob im individuellen Fall ein Behandlungsziel erstrebenswert und der dafür notwendige Behandlungsweg akzeptabel ist, hängt von den persönlichen Wünschen, Werthaltungen und Lebensentwürfen der Patientinnen und Patienten ab. Häufig bestehen Unsicherheiten darüber, ob ein patientenzentriertes Behandlungsziel erreicht werden kann. Der Einsatz eines zeitlich begrenzten Therapieversuches (TLT) als eine verbindliche Übereinkunft zwischen dem Behandlungsteam und der Patientin/dem Patienten bzw. dem juristischen Stellvertretenden zu einem Behandlungskonzept über einen definierten Zeitraum auf der Intensivstation kann hilfreich sein, um Unsicherheiten zu reduzieren und die Fortführung intensivmedizinischer Maßnahmen im Sinne des/der Patient/in besser einordnen und rechtfertigen zu können.

show abstract

“…There is little evidence about how best to communicate about time-limited trials with patients and surrogates, but several approaches have been suggested ( 1 , 2 , 11 , 37 , 38 ). For example, some experts propose using the combined framing of “hope” and “worry” statements to express uncertainty and the range of potential outcomes to patients and surrogates when considering a time-limited trial ( 37 ). Communication with patients, surrogates, and families during a time-limited trial also presents an opportunity to introduce complementary palliative care concepts, such as spiritual care, symptom assessment and management, caregiver and family support, and care focused exclusively on comfort (e.g., hospice care models) ( 31 , 39 ).…”

Section: Section 3: Collaborative Planning and Clear Communication Wi...mentioning

confidence: 99%

Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report

Kruser,

Ashana,

Courtright

et al. 2024

Annals ATS

View full text Add to dashboard Cite

In critical care, the specific, structured approach to patient care known as a “time-limited trial” has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient’s response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial’s duration. The plan’s 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.

show abstract

Communicating About Time-Limited Trials

Cited by 12 publications

References 19 publications

Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses

Outcomes in Patients Perceived as Receiving Excessive Care by ICU Physicians and Nurses

Time-limited trials (TLT) in the intensive care unit

Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report

Contact Info

Product

Resources

About