Time Limited Trials in the ICU: A Podcast with Dong Chang and Richard Leiter

Time-limited trials. We've all probably used them before. We meet with patients and families. We agree to either start or continue a particular treatment to see if it helps in some specific way over some defined period of time. If it works as hoped, great, we continue the treatments. If not, we stop them. At least that is how it's supposed to go. On today's podcast we talk all about these time-limited trials with Dong Chang and Ricky Leiter. Dong was the lead author of a JAMA IM article looking at the outcomes of training staff to use time-limited trials as the default communication and care planning approach for critically ill patients in intensive care units. Ricky is the l ead author of the accompanying editorial and palliative care physician extraordinaire. We discussed with Dong and Ricky about the results of the JAMA IM study, which were pretty darn impressive. The intervention resulted in significant reductions in duration of ICU stay (7.4 v 8.7 days), fewer invasive procedures, but no change in mortality, and no change in family satisfaction rating (which was high before and after the intervention). We discuss potential reasons why the intervention worked, some limitations of the study, the role uncertainty plays in decision-making, and so much more (including nudging from our last podcast). If you want to read more about time-limited trials, check out these articles as well: Paula Spans NY Times article on Time limited trials titled " I need to know I tried " The JAMA IM study and editorial on time-limited trials Tim Quill and Robert Holloways article in JAMA on Time-Limited Trials from 2011 And lastly our nudging podcast that we brought up several times