PARTNER II: Improving Patient and Family Centered Care in Advanced Critical Illness

This is a stepped wedged randomized controlled trial comparing the PARTNER intervention with
usual care in 5 Intensive Care Units. The overarching goal of this research project to ensure
patient-centered decisions about the use of intensive treatments for patients with advanced
critical illness. In a prior project, the investigators developed the PARTNER program
(PAiring Re-engineered ICU Teams with Nurse-driven Education and OutReach), a 4-facet,
team-based intervention that re-engineers how surrogates are supported in ICUs, including: 1)
changing care "defaults" to ensure clinician-family meetings within 48 hours of enrollment
and frequently thereafter; 2) protocolized, nurse-administered coaching and emotional support
of surrogates before and during clinician-family meetings, 3) increased use of palliative
care services for patients with a poor prognosis. The investigators propose to begin
deployment of the PARTNER II program in the spring of 2015 enrolling 690 surrogate decision
makers in 5 ICUs using a stepped wedge design. The investigators expect to achieve the
following project goals:

1. To increase the patient-centeredness of end-of-life decisions, and to increase the
quality of clinician-family communication.

2. To decrease the psychological burden on family members acting as surrogates.

3. To reduce total health care costs by decreasing the duration of use of burdensome,
invasive treatments at the end of life.