Randomized Trial of a Shared Decision-Making Tool to Guide Goals of Care Discussions in Hospitalized Patients Aged 80 and Older

What this Trial Is About

Researchers are evaluating a shared decision-making tool designed to help elderly hospitalized patients, aged 80 and older, communicate their treatment preferences regarding end-of-life care. The study aims to improve how well patients wishes about resuscitation and life-support treatments are identified, documented, and respected. This randomized clinical trial compares the new tool with usual care, focusing on hospitalized patients with acute medical or surgical conditions. The study is conducted at a single center and includes patients who have existing or prior documented preferences about life-sustaining treatments. Participants are randomly assigned to one of two groups one uses an intensive care unit-facilitated goals-of-care discussion supported by a web-based shared decision-making software called the GOCD Tool, which includes components on health status, prognosis, and care goals. The other group receives usual care, where attending physicians conduct discussions using their standard methods. The trial measures how these approaches impact ICU use, ventilator and dialysis days during and after hospitalization, and whether treatment preferences are properly documented and followed. Throughout the study, participants will have their ICU-related healthcare utilization tracked from hospital admission up to 12 months post-admission or until death. Researchers will assess changes in resuscitation preferences, quality of communication, patient satisfaction, and healthcare costs. The study includes evaluations of decision-making conflicts and barriers to implementing the tool. Monitoring includes assessments of treatment preferences recorded in patients medical records and the time needed to complete the goals-of-care discussions.

Eliciting Informed Goals of Care in Elderly Patients