# A Randomized Clinical Trial of Scenario Planning for Older Adults with Serious Injury

> **NIH NIH R01** · UNIVERSITY OF WISCONSIN-MADISON · 2024 · $866,426

## Abstract

ABSTRACT
 For older adults, poor communication about serious injury and life-limiting illness has consequences for
patients and families, clinicians, and healthcare systems. Afflicting 500,000 older adults annually, treatment for
traumatic injury frequently involves burdensome interventions (like prolonged life support), major changes in
functional or cognitive status, and high mortality. Surgeons use mortality statistics to communicate about the
gravity of illness, but current communication standards often lead to goal discordant care, moral distress for
clinicians, and prolongation of the dying process. Given high treatment burdens and frequency of poor
prognosis, seriously injured older adults would benefit from communication interventions that clarify patients'
goals, alleviate conflict in the ICU, and reduce unwanted invasive procedures for dying patients.
 A Randomized Clinical Trial of Scenario Planning for Older Adults with Serious Injury is a 5-year
R01 Clinical Trial that responds specifically to NOSI-AG-20-041 for evaluation of decision support tools and
communication aids for seriously ill older patients and their surrogate decision-makers to achieve goal-
concordant care. We have developed a novel communication tool called Best Case/Worst Case-ICU that uses
scenario planning—narrative description of plausible futures—and a graphic aid to illustrate information about
the patient's care trajectory and overall prognosis for daily use in the trauma ICU. We pilot tested this
intervention and found that surgeons can use this tool to support families and it may improve quality of
communication and reduce clinician moral distress. We are now ready to test the intervention in a large-scale
effectiveness study. We propose a pragmatic multisite randomized clinical trial following 4,500 older adults with
traumatic injury. We aim to test the effectiveness of the Best Case/Worst Case-ICU intervention on quality of
communication (Aim 1), clinician moral distress (Aim 2), and length of stay in the ICU (Aim 3).
 This award will allow us to test an intervention that is easily scalable and can be disseminated rapidly
for use with older adults with serious illness. The research is innovative because it tests scenario planning —a
decision-making strategy that has been successfully applied in business and government—but is not widely
used in healthcare. The research is significant because, if we demonstrate effectiveness, it has the potential to
transform how surgeons and other ICU clinicians talk with patients and families about treatment and prognosis
and dramatically improve care older adults receive in the trauma ICU. Our multidisciplinary team has a long
history of collaboration and is well positioned to achieve our objectives. The feasibility of this study is enhanced
by support from the Coalition for National Trauma Research, which comprises the major trauma professional
organizations in the United States and uses the American College of Surgeons' ...

## Key facts

- **NIH application ID:** 10886119
- **Project number:** 5R01AG078242-03
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Margaret Schwarze
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $866,426
- **Award type:** 5
- **Project period:** 2022-09-30 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10886119

## Citation

> US National Institutes of Health, RePORTER application 10886119, A Randomized Clinical Trial of Scenario Planning for Older Adults with Serious Injury (5R01AG078242-03). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10886119. Licensed CC0.

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