Paula Span reports for The New York Times on a health care initiative that can help make end-of-life decisions for individuals and their families a little easier. A “time-limited trial” offers treatment for ICU patients unable to speak for themselves to determine whether their conditions can improve. These types of trials help inform patients and their families as to whether prolonged life-sustaining treatment makes sense.
Patients and their families often understand the risks of on-going treatment at what appears to be the end of life when the patient is in the hospital intensive care unit. Treatment can prolong pain and impair quality of life. But, they want to explore whether treatment has benefits. For example, a time-limited trial might determine whether a patient was likely to remain in a coma or continue unconscious.
It’s unclear how often doctors let patients know that a time-limited trial is an option. But, doctors are becoming more aware of this concept. And, a recent JAMA Internal Medicine piece describes a study of these time-limited trials in three hospitals in Los Angeles.
Researchers trained 50 doctors on the use of time-limited trials and surveyed 200 patients, half of whom participated in time-limited trials. As a general rule, these trials occur when the medical team overseeing a patient does not believe the patient is likely to live or live a quality life that the patient would want. Yet, the patients family wants to believe that this is not the case, that their loved one’s condition will improve.
In a time-limited trial, family members discuss their loved ones’ end-of-life desires with the medical team. The medical team, in turn, explains the interventions it can make to prolong a patient’s life, as well as the risks of these interventions. They often involve sedating the patient.
Depending upon the treatment, the medical team and the patient’s family then decide how much time they want to give the patient on the treatment. It could be anywhere from a day to several days. The medical team establishes targets over this time to assess whether the treatment is benefiting the patient. If a patient has not improved within that time, the family and the medical team agree on a plan for stopping the treatment.
The researchers found that time-limited trials improved medical team engagement with family members around end-of-life decisions. With time-limited trials, family members participated in decision making early on and in all but four percent of cases. It also put family members at greater ease regarding end-of-life decisions. Without the trials, family members failed to engage on end-of-life questions 40 percent of the time.
In addition, the time-limited trials reduced patients’ stays in intensive care units. A much smaller number of them, it appears, chose interventions. But, patients in these trials died at about the same rate as patients who did not participate in these trials.
Here’s more from Just Care:
Leave a Reply