Caring for critically ill patients in the intensive care unit (ICU) can involve dozens of treatments, tests, and procedures each day. Many of these interventions are relatively harmless and routine. Others must be performed quickly in response to emergencies. Some interventions are risky and may inadvertently harm a patient.
All interventions should be performed to help patients achieve their treatment goals.
Critical Care Aligned with Patient Goals (CCAPG) explores whether it's possible to measure whether major preference-sensitive interventions performed in the ICU are concordant with a patient's goals.
We have proposed a methodology for measuring the incidence of goal-concordant care in the ICU setting. The feasibility of this proposal is now being tested.
The first step toward testing this method was to develop a list of common ICU interventions indicative of a major clinical decision requiring clear knowledge of a patient's treatment goals. A panel of ICU physicians, nurses, former ICU patients, and patient-surrogates in the mid-Atlantic region developed this list using a modified Delphi technique. The results of the modified Delphi process were published in Heart & Lung in 2016.
The next step was to assess the inter-rater agreement of ICU physicians tasked with determining whether interventions will help patients reach their goals. The Journal of Pain and Symptom Management published these results in 2018 (DOI: 10.1016/j.jpainsymman.2018.06.003). Accessing the published journal article requires a subscription to the journal or to ScienceDirect. However, we are able to publicly share the accepted version of the manuscript via a Creative Commons license.
Future planned studies:
- A clinical pilot to estimate retention and missing data rates for patients and their proxies enrolled in studies estimating the incidence of goal-concordant ICU care.
- A validation study of the correlation between goal-concordant care and recommended process measures, communication quality, shared decision-making, decision regret, and costs.
- Qualitative interviews with ICU clinicians, families and patients to understand the origins of care rated as goal-discordant.