{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T01:26:50Z","timestamp":1769131610211,"version":"3.49.0"},"reference-count":129,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Expert recommendations to discuss prognosis and offer palliative options for critically ill patients at high risk of death are variably heeded by intensive care unit (ICU) clinicians. How to best promote such communication to avoid potentially unwanted aggressive care is unknown. The PONDER-ICU (Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU) study is a 33-month pragmatic, stepped-wedge cluster randomized trial testing the effectiveness of two electronic health record (EHR) interventions designed to increase ICU clinicians\u2019 engagement of critically ill patients at high risk of death and their caregivers in discussions about all treatment options, including care focused on comfort. We hypothesize that the quality of care and patient-centered outcomes can be improved by requiring ICU clinicians to document a functional prognostic estimate (intervention A) and\/or to provide justification if they have not offered patients the option of comfort-focused care (intervention B). The trial enrolls all adult patients admitted to 17 ICUs in 10 hospitals in North Carolina with a preexisting life-limiting illness and acute respiratory failure requiring continuous mechanical ventilation for at least 48 hours. Eligibility is determined using a validated algorithm in the EHR. The sequence in which hospitals transition from usual care (control), to intervention A or B and then to combined interventions A\u2009+\u2009B, is randomly assigned. The primary outcome is hospital length of stay. Secondary outcomes include other clinical outcomes, palliative care process measures, and nurse-assessed quality of dying and death.<\/jats:p>\n                  <jats:p>Clinical trial registered with clinicaltrials.gov (NCT 03139838).<\/jats:p>","DOI":"10.1513\/annalsats.202002-088sd","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T16:48:52Z","timestamp":1600274932000},"page":"336-346","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":11,"title":["Prognosticating Outcomes and Nudging Decisions with Electronic Records in the Intensive Care Unit Trial Protocol"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3572-9857","authenticated-orcid":false,"given":"Katherine R.","family":"Courtright","sequence":"first","affiliation":[{"name":"Palliative and Advanced Illness Research Center, and"},{"name":"Department of Medicine, Perelman School of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich M.","family":"Dress","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaspal","family":"Singh","sequence":"additional","affiliation":[{"name":"Critical Care Network and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian A.","family":"Bayes","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzana","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan S.","family":"Small","sequence":"additional","affiliation":[{"name":"Department of Statistics, The Wharton School, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Hetherington","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research & Evaluation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Plickert","sequence":"additional","affiliation":[{"name":"Information and Analytics Services, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Detsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mount Sinai Health System, Toronto, Ontario, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason N.","family":"Doctor","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0553-674X","authenticated-orcid":false,"given":"Michael O.","family":"Harhay","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research Center, and"},{"name":"Department of Medicine, Perelman School of Medicine"},{"name":"Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry L.","family":"Burke","sequence":"additional","affiliation":[{"name":"Division of Palliative Care, Adult Acute Division and Department of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael B.","family":"Green","sequence":"additional","affiliation":[{"name":"Critical Care Network and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toan","family":"Huynh","sequence":"additional","affiliation":[{"name":"Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of General Surgery, Atrium Health System, Charlotte, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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