Evidence map›Paper›PMID 38851216›Full record

Trial reportAge and ageing2024

Impact of a prospective feedback loop aimed at reducing non-beneficial treatments in older people admitted to hospital and potentially nearing the end of life. A cluster stepped-wedge randomised controlled trial.

Nicole M White, Adrian G Barnett, Xing J Lee, Alison Farrington, Hannah Carter, Steven M McPhail, Magnolia Cardona, Kenneth Hillman, Leonie Callaway, Lindy Willmott and 4 more

Abstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Age and ageing, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Observational
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Nicole M WhiteAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Adrian G BarnettAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Xing J LeeAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Alison FarringtonAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Hannah CarterAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Steven M McPhailAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Magnolia CardonaBond University Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
Kenneth HillmanSimpson Centre for Health Services Research, South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.
Leonie CallawayRoyal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Lindy WillmottAustralian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Ben P WhiteAustralian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Gillian HarveyAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Nicholas GravesAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Christine BrownAustralian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.ORCID 0009-0003-8050-3934

Funding

National Health and Medical Research Council GNT1151923
6 · The paper itself

Abstract

objectivesTo investigate if a prospective feedback loop that flags older patients at risk of death can reduce non-beneficial treatment at end of life.

designProspective stepped-wedge cluster randomised trial with usual care and intervention phases.

settingThree large tertiary public hospitals in south-east Queensland, Australia.

participants14 clinical teams were recruited across the three hospitals. Teams were recruited based on a consistent history of admitting patients aged 75+ years, and needed a nominated lead specialist consultant. Under the care of these teams, there were 4,268 patients (median age 84 years) who were potentially near the end of life and flagged at risk of non-beneficial treatment.

interventionThe intervention notified clinicians of patients under their care determined as at-risk of non-beneficial treatment. There were two notification flags: a real-time notification and an email sent to clinicians about the at-risk patients at the end of each screening day. The nudge intervention ran for 16-35 weeks across the three hospitals.

main outcome measuresThe primary outcome was the proportion of patients with one or more intensive care unit (ICU) admissions. The secondary outcomes examined times from patients being flagged at-risk.

resultsThere was no improvement in the primary outcome of reduced ICU admissions (mean probability difference [intervention minus usual care] = -0.01, 95% confidence interval -0.08 to 0.01). There were no differences for the times to death, discharge, or medical emergency call. There was a reduction in the probability of re-admission to hospital during the intervention phase (mean probability difference -0.08, 95% confidence interval -0.13 to -0.03).

conclusionsThis nudge intervention was not sufficient to reduce the trial's non-beneficial treatment outcomes in older hospital patients.

trial registrationAustralia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).

Indexed as

Terminal CareAgedAged, 80 and overAge FactorsFeedbackFemaleHumansIntensive Care UnitsMaleMedical FutilityPatient AdmissionProspective StudiesQueenslandRisk Assessmentadvance care planningend of lifenon-beneficial treatmentolder peoplestepped-wedge trial

Identifiers

PMID38851216
PMCPMC11162291

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.