How I Do It: Communicating around Time Limited Trials.

Abstract Time limited trials (TLTs) are used in the management of critical care patients undergoing potentially non-beneficial interventions in order to improve prognostication and build trust and consensus between family and intensivists. When these trials are not well-defined and executed, discordant views of the patient’s prognosis, conflict and continuation of non-beneficial care can arise. The mnemonic TIME (Truth about uncertainty in prognosis, Interval of time, Measurement of improvement, and End or Extend) can help facilitate clear communication surrounding TLTs. This framework allows physicians and families to deal more effectively with the inherent uncertainty and required flexibility needed in caring for complex critical care patients. This can lead to patient-centered decision-making that improves patient-physician relationships and goal-concordant care and also potentially reduces non-beneficial treatments at the end of life.