Best Case/Worst Case-ICU: protocol for a multisite, stepped-wedge, randomised clinical trial of scenario planning to improve communication in the ICU in US trauma centres for older adults with serious injury
Deborah M Stein,
Karen Brasel,
Jan Jansen,
Rachel Morris,
Rosemary A Kozar,
Kathleen M O'Connell,
Stephanie Lueckel,
Anne Buffington,
Christine S Cocanour,
Amy Zelenski,
Bret M Hanlon,
Lily Stalter,
Kristine L Kwekkeboom,
Margaret Schwarze,
Mark D Cipolle,
Anamaria J Robles,
Rondi B Gelbard,
Kyle J Bushaw,
Melanie Fritz,
Patricia Ayoung-Chee
Affiliations
Deborah M Stein
University of Maryland Baltimore, Baltimore, Maryland, USA
Karen Brasel
Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
Jan Jansen
Division of Trauma and Acute Care Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
Rachel Morris
1 Paediatric Infant Perinatal Emergency Retrieval, Royal Children`s Hospital, Parkville, Victoria, Australia
Rosemary A Kozar
5 Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
Kathleen M O'Connell
Surgery, University of Washington, Seattle, Washington, USA
Stephanie Lueckel
13 Division of Acute Care Surgery and Surgical Critical Care, Brown University, Providence, Rhode Island, USA
Anne Buffington
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
Christine S Cocanour
Surgery, University of California Davis, Davis, California, USA
Amy Zelenski
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
Bret M Hanlon
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Lily Stalter
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
Kristine L Kwekkeboom
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
Margaret Schwarze
Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
Mark D Cipolle
Lehigh Valley Health Network, Allentown, Pennsylvania, USA
Anamaria J Robles
Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
Rondi B Gelbard
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
Kyle J Bushaw
1 Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
Melanie Fritz
1 Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
Patricia Ayoung-Chee
11 Department of Surgery, Morehouse School of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
Introduction Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.Methods and analysis We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or ‘like family’ member per eligible patient 5–7 days following their loved ones’ admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients’ length of stay in the ICU.Ethics and dissemination Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings.Trial registration number NCT05780918.
