Trial of Therapy

00:01 So, as I said, I think it's important when you're considering life-sustaining treatments, whether or not to have a trial of therapy. So, you don't know whether the treatment's going to work.

00:12 You anticipate that there might be, you know, burdens to instituting the treatment but you want to give the person the chance.

00:18 So, when there is uncertainty about the effectiveness of a treatment, you have a discussion with the patient or the family about goals of care.

00:27 You say, "Okay, we're going to have a trial of therapy." You start the treatment.

00:33 You decide together, well, if it's not working after some period of assessment and it's really not meeting the original goals that we had in mind, then, we would consider stopping the treatment.

00:46 Generally, trials of therapy are going to be time limited.

00:49 So, you're going to specify the amount of time that you would do this reevaluation, whether it's two weeks, whether it's one week, whether it's a few days.

00:57 What are going to be the milestones you look for to see if there's been some response to the treatment? And then, what counts as effectiveness? Is it just keeping the person alive? Is it some demonstration that they actually are recovering from the condition? You want some measures whether it's laboratory measures or the patients' ability to interact with you.

01:21 Some showing of effectiveness of the treatment.

01:27 And then, once you've had the trial of therapy, once that period of time has ended, then, you're going to have a repeat discussion.

01:33 Where are we? Where do things stand? Have our goals of care been met? Do we need to redefine the goals of care? Maybe there've been, you know, some signs of improvement but not what we were hoping for.

01:45 Do we keep going for a little bit longer, a new trial of therapy to see if those additional goals could be met? Do we reevaluate and maybe decide to withdraw the treatment? So, that's the purpose of the trial of therapy.