Development and Implementation of a Clinician-Facing Prognostic Communication Tool for Patients With COVID-19 and Critical Illness

Lindsay M Gibbon; Katherine E GrayBuck; Laura I Buck; Kuang-Ning Huang; Neela L Penumarthy; Shirou Wu; J Randall Curtis

doi:10.1016/j.jpainsymman.2020.05.005

Development and Implementation of a Clinician-Facing Prognostic Communication Tool for Patients With COVID-19 and Critical Illness

J Pain Symptom Manage. 2020 Aug;60(2):e1-e6. doi: 10.1016/j.jpainsymman.2020.05.005. Epub 2020 May 8.

Authors

Lindsay M Gibbon¹, Katherine E GrayBuck², Laura I Buck¹, Kuang-Ning Huang³, Neela L Penumarthy⁴, Shirou Wu¹, J Randall Curtis⁵

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
² Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Spiritual Care, University of Washington, Seattle, Washington, USA.
³ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Family Medicine, University of Washington, Seattle, Washington, USA.
⁴ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA.
⁵ Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA. Electronic address: jrc@u.washington.edu.

Abstract

Effective prognostication for a novel disease presents significant challenges, especially given the stress induced during a pandemic. We developed a point-of-care tool to summarize outcome data for critically ill patients with COVID-19 and help guide clinicians through a thoughtful prognostication process. Two authors reviewed studies of outcomes of patients with critical illness due to COVID-19 and created a visual infographic tool based on available data. Survival data were supplemented by descriptions of best- and worst-case clinical scenarios. The tool also included prompts for clinician reflection designed to enhance awareness of cognitive biases that may affect prognostic accuracy. This online, open-source COVID-19 Prognostication Tool has been made available to all clinicians at our institution and is updated weekly to reflect evolving data. Our COVID-19 Prognostication Tool may provide a useful approach to promoting consistent and high-quality prognostic communication across a health care system.

Keywords: COVID-19; communication; palliative care; prognosis.

MeSH terms

Aged
COVID-19
Coronavirus Infections / diagnosis*
Coronavirus Infections / therapy
Critical Care
Critical Illness
Data Visualization
Diagnosis, Computer-Assisted* / methods
Health Communication* / methods
Health Personnel / psychology
Humans
Internet
Middle Aged
Palliative Care / methods
Pandemics
Pneumonia, Viral / diagnosis*
Pneumonia, Viral / therapy
Point-of-Care Systems
Prejudice
Prognosis