The Effect of a Needs-targeted Intervention on Racial Disparities in Unmet Needs of Patients and Families in the Intensive Care Unit

The quality of palliative care is highly variable for the nearly 5 million annual intensive care unit (ICU) admissions. Family members report poor quality communication and decision-making, and clinicians struggle to identify needs and connect with families in a shiftwork environment.

These markers of poor quality disproportionately impact Black patients and families. Compared to Whites, Blacks report lower satisfaction with the quality of ICU care, and studies document disparities in multiple domains of patient-centered care in the ICU.

Barriers to improving the quality of care in the ICU include difficulty identifying high risk patients and families with unmet care needs, coordinating care by ICU teams, and engaging diverse family decision makers as partners in the care process.

To address these barriers, our team developed a mobile application, PCneeds, with the input of families and clinicians of diverse race and ethnicity. PCneeds systematically engages families and helps ICU clinicians deliver needs-targeted care.

Our overall goal is to determine if PCneeds can provide a scalable palliative care delivery model to improve care quality for racially and ethnically diverse groups and reduce disparities in ICU care.

The specific aims of this project are to:

  1. Determine the effect of the PCneeds intervention versus usual care on unmet needs and perceptions of the quality of patient-centered care for Black and White patients and families in the ICU
  2. Determine the effect of the PCneeds intervention versus usual care on racial disparities in unmet needs and in the quality of patient-centered care.

At the conclusion of this study, we will be prepared to conduct a pragmatic clinical trial of PCneeds as an innovative, generalizable and highly scalable approach to addressing disparities in ICU care as well as in other care settings.

Objectives: Assess effect of needs-based care on family unmet needs in ICU

Methods: Cluster randomized controlled trial (RCT) of ICU clinicians and family caregivers

Intervention: PCneeds Mobile App: families report needs on the app, care team receives this information; clinicians encouraged to address needs and receive decisional support to do so. 

Outcomes:

  1. Change in unmet needs
  2. Patient-centered care
  3. ICU length of stay (LOS)

Project Leadership

Principal Investigator: Christopher Cox,  MD 

Co-Investigator: Isaretta Riley, MD 

Co-Investigator: Sharron Docherty, PhD