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Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial.

Publication ,  Journal Article
Cox, CE; Ashana, DC; Riley, IL; Olsen, MK; Casarett, D; Haines, KL; O'Keefe, YA; Al-Hegelan, M; Harrison, RW; Naglee, C; Katz, JN; Yang, H ...
Published in: JAMA Netw Open
January 2, 2024

IMPORTANCE: Unmet and racially disparate palliative care needs are common in intensive care unit (ICU) settings. OBJECTIVE: To test the effect of a primary palliative care intervention vs usual care control both overall and by family member race. DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted at 6 adult medical and surgical ICUs in 2 academic and community hospitals in North Carolina between April 2019 and May 2022 with physician-level randomization and sequential clusters of 2 Black patient-family member dyads and 2 White patient-family member dyads enrolled under each physician. Eligible participants included consecutive patients receiving mechanical ventilation, their family members, and their attending ICU physicians. Data analysis was conducted from June 2022 to May 2023. INTERVENTION: A mobile application (ICUconnect) that displayed family-reported needs over time and provided ICU attending physicians with automated timeline-driven communication advice on how to address individual needs. MAIN OUTCOMES AND MEASURES: The primary outcome was change in the family-reported Needs at the End-of-Life Screening Tool (NEST; range 0-130, with higher scores reflecting greater need) score between study days 1 and 3. Secondary outcomes included family-reported quality of communication and symptoms of depression, anxiety, and posttraumatic stress disorder at 3 months. RESULTS: A total of 111 (51% of those approached) family members (mean [SD] age, 51 [15] years; 96 women [86%]; 15 men [14%]; 47 Black family members [42%]; 64 White family members [58%]) and 111 patients (mean [SD] age, 55 [16] years; 66 male patients [59%]; 45 Black patients [41%]; 65 White patients [59%]; 1 American Indian or Alaska Native patient [1%]) were enrolled under 37 physicians randomized to intervention (19 physicians and 55 patient-family member dyads) or control (18 physicians and 56 patient-family member dyads). Compared with control, there was greater improvement in NEST scores among intervention recipients between baseline and both day 3 (estimated mean difference, -6.6 points; 95% CI, -11.9 to -1.3 points; P = .01) and day 7 (estimated mean difference, -5.4 points; 95% CI, -10.7 to 0.0 points; P = .05). There were no treatment group differences at 3 months in psychological distress symptoms. White family members experienced a greater reduction in NEST scores compared with Black family members at day 3 (estimated mean difference, -12.5 points; 95% CI, -18.9 to -6.1 points; P < .001 vs estimated mean difference, -0.3 points; 95% CI, -9.3 to 8.8 points; P = .96) and day 7 (estimated mean difference, -9.5 points; 95% CI, -16.1 to -3.0 points; P = .005 vs estimated mean difference, -1.4 points; 95% CI, -10.7 to 7.8; P = .76). CONCLUSIONS AND RELEVANCE: In this study of ICU patients and family members, a primary palliative care intervention using a mobile application reduced unmet palliative care needs compared with usual care without an effect on psychological distress symptoms at 3 months; there was a greater intervention effect among White family members compared with Black family members. These findings suggest that a mobile application-based intervention is a promising primary palliative care intervention for ICU clinicians that directly addresses the limited supply of palliative care specialists. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03506438.

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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

January 2, 2024

Volume

7

Issue

1

Start / End Page

e2349666

Location

United States

Related Subject Headings

  • White
  • Mobile Applications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Family
  • Critical Illness
  • Communication
  • Black or African American
 

Citation

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Cox, C. E., Ashana, D. C., Riley, I. L., Olsen, M. K., Casarett, D., Haines, K. L., … Johnson, K. S. (2024). Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial. JAMA Netw Open, 7(1), e2349666. https://doi.org/10.1001/jamanetworkopen.2023.49666
Cox, Christopher E., Deepshikha C. Ashana, Isaretta L. Riley, Maren K. Olsen, David Casarett, Krista L. Haines, Yasmin Ali O’Keefe, et al. “Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial.JAMA Netw Open 7, no. 1 (January 2, 2024): e2349666. https://doi.org/10.1001/jamanetworkopen.2023.49666.
Cox CE, Ashana DC, Riley IL, Olsen MK, Casarett D, Haines KL, et al. Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2349666.
Cox, Christopher E., et al. “Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial.JAMA Netw Open, vol. 7, no. 1, Jan. 2024, p. e2349666. Pubmed, doi:10.1001/jamanetworkopen.2023.49666.
Cox CE, Ashana DC, Riley IL, Olsen MK, Casarett D, Haines KL, O’Keefe YA, Al-Hegelan M, Harrison RW, Naglee C, Katz JN, Yang H, Pratt EH, Gu J, Dempsey K, Docherty SL, Johnson KS. Mobile Application-Based Communication Facilitation Platform for Family Members of Critically Ill Patients: A Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2349666.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

January 2, 2024

Volume

7

Issue

1

Start / End Page

e2349666

Location

United States

Related Subject Headings

  • White
  • Mobile Applications
  • Middle Aged
  • Male
  • Humans
  • Female
  • Family
  • Critical Illness
  • Communication
  • Black or African American