Time Limited Trials May Benefit Critically Ill Patients

Here is some timely medical research in JAMA INTERNAL MEDICINE that links directly into active public policy debates in Texas, Ontario, and other jurisdictions.

The research shows that time-limited trials may have benefits in critically ill patients such as improving communication with family, and decreasing the duration and intensity of nonbeneficial treatments.

Time limited trials are mutually agreed-upon care plans that propose the use of a treatment or procedure, such as mechanical ventilation, for a set amount of time. Both the clinician and family/surrogate decision maker agree on the next steps should the patient improve, decline, or remain the same at the end of the trial period. Time limited trials promote regular structured dialogue and consensus between clinicians and families. They also set rational boundaries to treatments based on goals of care and help reassure families that all indicated interventions are pursued.

In sum, the study highlights an approach that prioritizes patients' values and preferences and may reduce disproportionate use of nonbeneficial ICU treatments.

But in jurisdictions like Ontario, and perhaps Texas if current legislation is enacted, clinicians would be unable to withdraw treatment without family consent after a time limited trial. Many clinicians claim that such a rule will chill clinicians from even starting a time limited trial. They will try if they can stop. But the are less likely to try if they will later be unable to stop when the deployed interventions fail to help the patient. But the benefit of time limited trials may outweigh this risk.