A Communication Tool to Assist Severely Injured Older Adults

The purpose of this study is to test the effect of the "best case/worse case" communication
tool on the quality of communication with older patients admitted to two trauma units and to
collect feedback on the tool to help adapt it to the trauma setting. The intervention was
developed and tested with acute care surgical patients at the University of Wisconsin (UW)
and the present study seeks to test whether the intervention will work in a different
setting.

To adapt the tool to trauma settings, we will conduct focus groups at UW Health Oregon Health
Sciences University (OHSU) and Parkland Memorial Hospital (PMH) at the University of
Texas-Southwestern (UT-S). Because trauma care is delivered by a multidisciplinary team, we
will include attending trauma surgeons, surgical residents, ICU nurses, nurse practitioners,
consulting physicians (e.g. orthopedic surgeons) and others on the trauma care team. Up to 60
trauma car providers will participate in focus groups across the three sites. We will test
the intervention with severely injured older adults at OHSU and UT-S/PMH. In the first year,
UT-S/PMH and OHSU will recruit and enroll 50 patients total in the control arm and train
trauma surgeons to use the best case/worst case tool. In the second year, UT-S/PMH and OHSU
will recruit and enroll 50 patients total in the intervention arm.

UT-S/PMH and OHSU research team members will survey family members of trauma patients to
compare the quality of communication for severely injured geriatric trauma patients cared for
by trauma teams. When possible, UT-S/PMH and OHSU will survey patients on their quality of
life. UT-S/PMH and OHSU will survey the patient's primary nurse on the quality of
communication patients and will survey patient's families about their thoughts on the quality
of communication as well. UT-S/PMH and OHSU will survey trauma unit staff before and after
clinicians learn to use the best case/worst case tool, to assess whether the communication
intervention improves feelings of moral distress. UT-S/PMH and OHSU will use chart review to
collect downstream clinical outcomes including intensity of treatment and receipt of
palliative care. UT-S/PMH and OHSU will archive de-identified graphic aids used by trauma
surgeons with intervention patients to explore how the intervention was enacted.

Patients

Inclusion Criteria:

- Traumatically injured patients 60 and older admitted to the ICU

Exclusion Criteria:

- Surgeons will have an opportunity to exclude a patient or family who, in the
physician's judgment, would not be an appropriate participant

- Patients with a Physician Orders for Life-Sustaining Medical Treatment (POLST) or
Medical Orders for Life-Sustaining Medical Treatment (MOLST) form on file in their
medical record that specifies that the patient or their decision maker wishes them to
receive no intervention

- Patients with an isolated head injury as defined by a Head Abbreviated Injury Scale
(AIS) score of 2 or less and an External AIS score of 1 or 0 and a Glasgow Coma Scale
(GCS) score of 15. This serves to exclude the mildly traumatically brain injured
patients with minimal external injuries who require ICU-level monitoring for a short
period of time only

Family Members

Inclusion Criteria:

Exclusion Criteria:

- We will exclude patients whose family members do not speak English

- Under the age of 18

- Lack decision making capacity (DMC)

- Have a severe hearing or vision impairment.

Surgeons

Inclusion Criteria:

Exclusion Criteria:

- Care providers who do not directly provide primary trauma care in the ICU

- Residents who have not had at least 5 years of postgraduate training

- Trauma consultants including for example, neurosurgeons, orthopedic surgeons, and
otolaryngologists

Nurses

Inclusion Criteria:

- The nurse responsible for care of the enrolled patient at 3 days post-admission will
be invited to complete a Quality of Communication (QOC) survey assessment

Exclusion Criteria: