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Title: Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) and Hospitalized Elderly Longitudinal Project (HELP), 1989-1997      
dateReleased:
04-08-2015
downloadURL: http://dx.doi.org/10.3886/ICPSR02957.v1
ID:
doi:10.3886/ICPSR02957.v1
description:
The objective of the SUPPORT and HELP projects was to improve decision-making in order to address the growing national concern over the loss of control that patients have near the end of life and to reduce the frequency of a mechanical, painful, and prolonged process of dying. SUPPORT comprised a two-year prospective observational study (Phase I) followed by a two-year controlled clinical trial (Phase II). Phase I of SUPPORT collected data from patients accessioned during 1989-1991 to characterize the care, treatment preferences, and patterns of decision-making among critically ill patients. It also served as a preliminary step for devising an intervention strategy for improving critically-ill patients' care and for the construction of statistical models for predicting patient prognosis and functional status. An intervention was implemented in Phase II of SUPPORT, which accessioned patients during 1992-1994. The Phase II intervention provided physicians with accurate predictive information on future functional ability, survival probability to six months, and patients' preferences for end-of-life care. Additionally, a skilled nurse was provided as part of the intervention to elicit patient preferences, provide prognoses, enhance understanding, enable palliative care, and facilitate advance planning. The intervention was expected to increase communication, resulting in earlier decisions to have orders against resuscitation, decrease time that patients spent in undesirable states (e.g., in the Intensive Care Unit, on a ventilator, and in a coma), increase physician understanding of patients' preferences for care, decrease patient pain, and decrease hospital resource use. Data collection in both phases of SUPPORT consisted of questionnaires administered to patients, their surrogates, and physicians, plus chart reviews for abstracting clinical, treatment, and decision information. Phase II also collected information regarding the implementation of the intervention, such as patient-specific logs maintained by nurses assigned to patients as part of the intervention. SUPPORT patients were followed for six months after inclusion in the study. Those who did not die within six months or were lost to follow-up were matched against the National Death Index to identify deaths through 1997. The HELP study was conducted in 1993 concomitantly with Phase II of SUPPORT and collected data to characterize the care, treatment preferences, and patterns of decision-making among hospitalized patients who were at least 80 years old. HELP data were also intended for use in adapting existing mortality and functional status models of elderly hospitalized patients. Data collection methods of HELP were essentially the same as those of SUPPORT. HELP patients were followed for 12 months after inclusion in the study. Patients who did not die within one year or were lost to follow-up were matched against the National Death Index to identify deaths through 1997.
description:
Knaus, William; Lynn, Joanne, 2015, "Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) and Hospitalized Elderly Longitudinal Project (HELP), 1989-1997", http://dx.doi.org/10.3886/ICPSR02957.v1
name:
Knaus, William
Lynn, Joanne
homePage: http://www.harvard.edu/
name:
Harvard University
ID:
SCR:011273
abbreviation:
DataVerse
homePage: http://thedata.org/
name:
Dataverse Network Project
ID:
SCR:001997