death—and many patients died after long stays in intensive care units (ICUs) either comatose or with mechanical ventilation.
The Phase II intervention employed a skilled nurse specialist to interact with patients and their families, staff, and the intervention physicians. Specifically,
All participating physicians also were given feedback on the overall results of the observational phase of the study, characterizing the shortcomings of physician-patient communication, pain, and the timing of DNR orders.
A form of “cluster randomization” (by physician specialty and study site) was used to assign patients to either the intervention or the usual-care groups (see SUPPORT Principal Investigators, 1995, for details). The evidence after enrollment of 4,804 patients in two years was examined for five outcomes:
None of the outcomes was better for patients in the intervention group than for those in the control group.
ently. This led RWJF to begin its Last Acts campaign, an effort to improve end-of-life care at the grassroots level that now has more than 400 members (Schroeder, 1999), and funding of demonstration programs to reduce the identified barriers to high-quality care for those who are dying.