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Critical Care Trial Participation Consent by SDMPhase 2NCT01232621

The Approach Study

A Phase 2 study testing Physician Introduction of research personnel in people with Critical Care Trial Participation Consent by SDM, run by Unity Health Toronto at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

In the Approach Study, the investigators will study the 'process' by which Substitute Decision Makers (SDMs) are approached for consent for their loved one's participation in critical care research. Read more about this study

Who is it for?
Any age
What is being tested?
Physician Introduction of research personnel
Could I receive a placebo?
No, everyone receives an active treatment
How many people
138 participants
Where
1 siteCanada
Study dates
Jul 2011to Nov 2012
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • SDMs of critically ill adults who are eligible (meet all inclusion criteria and have no exclusion criteria) to participate in a critical care research study in progress in the ICU

Who cannot join

  • Eligible critically ill adults who die or are transferred out of a participating ICU prior to being screened by a RC
  • Critically ill adults capable of providing primary consent for research participation.
  • We will limit participation to initial encounters (the same patient will not be included more than once)

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • St. Michael's Hospital

    Toronto, Ontario, M5B 1W8

Other trials in Canada

About this study

Official title: A Randomized Pilot Study of Different Methods of Approaching Substitute Decision Makers Regarding Research Participation in the Intensive Care Unit: The Approach Study

In the Approach Study, the investigators will study the 'process' by which Substitute Decision Makers (SDMs) are approached for consent for their loved one's participation in critical care research. The investigators will randomize SDMs of critically ill patients who are eligible to participate in any research study in operation to either 'physician introduction' of the research team or 'non-physician approach (non-physician)' in which research coordinators are introduced by allied health care team members or introduce themselves directly to SDMs. This study seeks to identify important features of the 'consent to research' process that can be modified to enhance both SDM satisfaction with the consent process and recruitment into critical care research studies.

Read the detailed description

Rationale: Conduct of clinical research in the intensive care unit (ICU) presents challenges including the necessity to obtain consent for patients lacking decision-making capacity, operationalize research protocols under emergency conditions and investigate conditions with high mortality. Most critically ill patients are unable to comprehend or communicate and Substitute Decision Makers (SDMs) typically provide consent for their research participation. SDMs of critically ill patients may be overwhelmed by the patient's circumstances and the amount of medical information presented to them. Preliminary data suggest that SDMs prefer physician involvement in the consent process.

Primary Objective: To demonstrate the ability to implement a randomized controlled trial (RCT) evaluating two different approaches for introducing research coordinators (RC) to SDMs (physician introduction vs. non physician introduction) for participating in ICU research studies.

Secondary Objectives: To describe, among SDMs approached for consent to participate in an ICU research study by either physician or non-physician introduction (e.g., nurse, social worker)]: (a) the proportion of SDMs providing and declining consent, (b) the time between meeting eligibility criteria and sentinel events (being approached for consent, and either providing or declining consent), (c) reasons for SDMs providing or declining consent, and (d) agreement between questionnaires completed by SDMs and RCs and physicians regarding their acceptance of and comfort and satisfaction with the approach utilized.

Study Overview: We will conduct a multicentre pilot RCT of different methods (physician vs. non-physician introduction of research personnel) for approaching SDMs for consent for a loved one to participate in critical care research at 3 ICUs in Ontario.

Study Population: This study will focus on the approach to SDMs (n=99) of critically ill adults who are eligible (meet all inclusion criteria and have no exclusion criteria) to participate in a critical care research study in progress during the data collection period, and which requires SDM consent.

Interventions: In the intervention arm physicians will introduce RCs and study participation to SDMs using a standardized script. In the control arm RCs will either introduce themselves or be introduced by a non-physician member of the health care teams. RCs will complete an "Event Form" each time a critically ill adult is eligible to participate in a study. "Site Forms" and "Study Forms" will capture ICU-related information and studies in operation over the study period, respectively. We will administer 3 to 8 item questionnaires to SDMs, RCs and physicians involved in consent encounters to describe their acceptance of and comfort and satisfaction with the approach utilized.

Study Outcomes: To demonstrate the feasibility of an RCT evaluating 2 methods of approaching SDMs for consent for research participation. Feasibility will be defined as (i) ≤ 15% of physician introductions will be missed due to lack of physician availability (physician introduction arm) and (ii) cross-overs (from either arm to the other) will occur in ≤ 15% of encounters. We will demonstrate that ≤ 20% of introductions (following randomization) will be missed due to inability of the research team to contact an identified SDM and at least 70% and 50% of initial and subsequent SDM questionnaires will be returned.

Relevance: The Approach Study will provide valuable information for stakeholders committed to ensuring the ethical basis of critical care research; and will guide the design of a larger RCT examining how to best approach SDMs of critically ill patients. Moreover it will provide insight on how to best approach SDMs to make encounters more comfortable, credible, informed and less burdensome for them. The Approach Study will provide the framework for a larger phase 3 study examining how to best approach SDMs.

Being tested
Physician Introduction of research personnel

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Physician Introduction of research personnelOther

    Also called Approach to Consent, Consent, Substitute Decision Maker

    Physicians will introduce Research Coordinators (RCs) by name and acknowledge patient eligibility to participate in a research study using a standardized script.

Study groups in NCT01232621
Study groupRoleWhat they receive
Physician introductionExperimentalPhysicians will introduce Research Coordinators (RCs) by name to SDMs and acknowledge patient eligibility to participate in a study using a standardized script.
Receives: Other: Physician Introduction of research personnel
Non-physician introduction (usual approach)Active comparatorRCs will either introduce themselves or be introduced by a non-physician member of the health care team.
Receives: Other: Physician Introduction of research personnel

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility Outcome

    Feasibility of the pilot study will be assessed by the following:

    1. We expect that (i) ≤ 15% of physician introductions will be missed due to lack of physician availability (physician introduction arm) and (ii) cross-overs (from either arm to the other) will occur in ≤ 15% on introductions.
    2. Following randomization, we expect that ≤ 20% of introductions will be missed due to inability of the RC to contact existing SDMs once identified (either intervention or control arm).
    3. We will obtain at least 70% of initial SDM questionnaires Part A and at least 50% of questionnaires Part B.

    Measured: 7 days

Secondary outcomes (1)
  1. Consent Obtained Vs Consent Declined

    1. describe the proportion of SDMs providing and declining consent when approached by a RC or accompanied by the most responsible physician and when an update accompanies an introduction.
    2. determine the time interval between critically ill patients' meeting eligibility criteria and sentinel events.
    3. elucidate reasons why SDMs provide or decline consent
    4. assess agreement between SDMs, RCs and attending physicians acceptance of and comfort and satisfaction with the alternative approaches

    Measured: 7 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Nov 2010 (estimated)
  2. Study startJul 2011
  3. Primary completionNov 2012
  4. Study completionNov 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
138 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01232621
Sponsor's protocol ID
10-278
Status last verified
Jan 2013
First submitted
28 Oct 2010
Last updated
7 Jan 2013
Results posted
No
Data monitoring committee
No

Publications

  • Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17. doi: 10.1056/NEJM199902113400601.

    PubMed 9971864
  • Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, Laporta DP, Viner S, Passerini L, Devitt H, Kirby A, Jacka M; Canadian Critical Care Clinical Trials Group. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003 Jan 2;348(1):5-14. doi: 10.1056/NEJMoa021108.

    PubMed 12510037
  • Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. Canadian Critical Care Trials Group. N Engl J Med. 1998 Mar 19;338(12):791-7. doi: 10.1056/NEJM199803193381203.

    PubMed 9504939
  • SHIMKIN MB. The problem of experimentation on human beings. I. The research worker's point of view. Science. 1953 Feb 27;117(3035):205-7. doi: 10.1126/science.117.3035.205. No abstract available.

    PubMed 13038475
  • Coppolino M, Ackerson L. Do surrogate decision makers provide accurate consent for intensive care research? Chest. 2001 Feb;119(2):603-12. doi: 10.1378/chest.119.2.603.

    PubMed 11171743
  • Azoulay E, Chevret S, Leleu G, Pochard F, Barboteu M, Adrie C, Canoui P, Le Gall JR, Schlemmer B. Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med. 2000 Aug;28(8):3044-9. doi: 10.1097/00003246-200008000-00061.

    PubMed 10966293
  • Pochard F, Azoulay E, Chevret S, Lemaire F, Hubert P, Canoui P, Grassin M, Zittoun R, le Gall JR, Dhainaut JF, Schlemmer B; French FAMIREA Group. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med. 2001 Oct;29(10):1893-7. doi: 10.1097/00003246-200110000-00007.

    PubMed 11588447
  • Bolmsjo I, Hermeren G. Interviews with patients, family, and caregivers in amyotrophic lateral sclerosis: comparing needs. J Palliat Care. 2001 Winter;17(4):236-40.

    PubMed 11813340
  • Upadya A, Muralidharan V, Thorevska N, Amoateng-Adjepong Y, Manthous CA. Patient, physician, and family member understanding of living wills. Am J Respir Crit Care Med. 2002 Dec 1;166(11):1430-5. doi: 10.1164/rccm.200206-503OC. Epub 2002 Sep 11.

    PubMed 12406822
  • Shalowitz DI, Garrett-Mayer E, Wendler D. The accuracy of surrogate decision makers: a systematic review. Arch Intern Med. 2006 Mar 13;166(5):493-7. doi: 10.1001/archinte.166.5.493.

    PubMed 16534034
  • Ciroldi M, Cariou A, Adrie C, Annane D, Castelain V, Cohen Y, Delahaye A, Joly LM, Galliot R, Garrouste-Orgeas M, Papazian L, Michel F, Barnes NK, Schlemmer B, Pochard F, Azoulay E. Ability of family members to predict patient's consent to critical care research. Intensive Care Med. 2007 May;33(5):807-813. doi: 10.1007/s00134-007-0582-6. Epub 2007 Mar 15.

    PubMed 17361388
  • Morley CJ, Lau R, Davis PG, Morse C. What do parents think about enrolling their premature babies in several research studies? Arch Dis Child Fetal Neonatal Ed. 2005 May;90(3):F225-8. doi: 10.1136/adc.2004.061986.

    PubMed 15846012
  • Scales DC, Smith OM, Pinto R, Barrett KA, Friedrich JO, Lazar NM, Cook DJ, Ferguson ND. Patients' preferences for enrolment into critical-care trials. Intensive Care Med. 2009 Oct;35(10):1703-12. doi: 10.1007/s00134-009-1552-y. Epub 2009 Jun 24.

    PubMed 19551372
  • Chenaud C, Merlani P, Verdon M, Ricou B. Who should consent for research in adult intensive care? Preferences of patients and their relatives: a pilot study. J Med Ethics. 2009 Nov;35(11):709-12. doi: 10.1136/jme.2008.028068.

    PubMed 19880710
  • Heyland DK, Rocker GM, Dodek PM, Kutsogiannis DJ, Konopad E, Cook DJ, Peters S, Tranmer JE, O'Callaghan CJ. Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med. 2002 Jul;30(7):1413-8. doi: 10.1097/00003246-200207000-00002.

    PubMed 12130954

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Physician Introduction of research personnel in people with Critical Care Trial Participation Consent by SDM, run by Unity Health Toronto at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Jan 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility Outcome (time frame: 7 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01232621, which also lists 16 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Jan 2013.

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