Time-Limited Trials: An Ethnographic Study Comparing Work-as-Envisioned to Work-as-Performed

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 03

AA

Arsalan Ahmad, MS (he/him/his)

Wisconsin

Disclosure(s): No relevant financial relationship(s) to disclose.
DW

Douglas A. Wiegmann, PhD

Professor
Department of Industrial and Systems Engineering, University of Wisconsin, Wisconsin

Disclosure information not submitted.
ON

Oliver Nguyen, MSHI

Graduate Research Assistant
Department of Industrial and Systems Engineering, University of Wisconsin, Wisconsin

Disclosure information not submitted.
JM

Joy Moy, MD, MPH, MS

Scientist
Division of Allergy, Pulmonary, and Critical Care; Department of Medicine, University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.
MP

Madison Polley, BA

Clinical Research Coordinator II
Division of Allergy, Pulmonary, and Critical Care; Department of Medicine, University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.
CO

Cemre Orhan, PhD

Researcher
University of Wisconsin

Disclosure information not submitted.
NN

Nandita R. Nadig, MD, MSCR

Associate Professor
Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
JC

Justin Clapp, PhD, MPH

Assistant Professor
Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
SH

Scott D. Halpern, MD, PhD, MBE

Professor
Division of Pulmonary, Allergy, and Critical Care; Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
KS

Katharine Secunda, MD (she/her/hers)

University of Pennsylvania

Disclosure(s): No relevant financial relationship(s) to disclose.
EV

Elizabeth M. Viglianti, MD MPH MSc

Assistant Professor
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan

Disclosure information not submitted.
BH

Bret Hanlon, PhD

Scientist III
Department of Biostatistics and Medical Informatics; University of Wisconsin

Disclosure information not submitted.
Andrew Wu, MD (he/him/his)

Disclosure(s): No relevant financial relationship(s) to disclose.
TR

Timothy Rowe, MD

Assistant Professor
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
HD

Helen Donnelly, MS, BSN, RN, CCRC

Clinical Research Nurse/Clinical Research Associate
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
FM

Francisco Martinez, BS

Research Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
EK

Erin Korth, BA

Research Project Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
LP

Lesley Pinzon, MPH

Research Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
EC

Emily Campbell, BA

Clinical Research Coordinator
Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
JK

Jacqueline Kruser, MD, MS

Assistant Professor
University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.

Introduction: Time-limited trials (TLT) are a flexible approach to decision-making about life-sustaining therapies amid uncertainty in critically ill patients. Though increasingly used in ICUs, their conduct varies widely and is shaped by clinician judgment and context. Amidst this wide variation in practice, we have little knowledge about what constitutes an optimal TLT. Understanding their real-world implementation is key to developing effective interventions to support optimal TLTs.

Methods: To examine how TLTs are implemented in clinical settings, we conducted a focused ethnography of patients (n = 30) undergoing TLTs in ICUs at five hospitals across the United States. Data sources included direct observations, electronic health record (EHR) notes, audio-recorded family meetings, and interviews with clinicians and family members. Guided by a prior Delphi study that established expert consensus on 17 essential elements of a TLT (“work-as-envisioned”), we developed a process map that served as the basis for a deductive content analysis of each TLT case to assess whether TLT elements were performed fully, partially, or not at all (“work-as-performed”).

Results: Across the 30 cases analyzed, none included all 17 work-as-envisioned TLT elements. On average, 72% of elements were addressed per case, with a range of 41.2% to 88.2%. Some elements, such as discussing patient goals, were consistently included (100%), along with planning elements like determining trial duration and post-trial reassessment elements, such as evaluating the patient's response to therapy (>90% inclusion). Others, such as discussing end-of-trial decisions (57%) and acceptable therapies (63%) appeared less frequently. Physician rotation occurred during 19 TLT cases, and in 2 of these cases, it resulted in post-trial reassessment elements not being completed.

Conclusions: Our findings extend the understanding of TLTs by identifying which elements are most and least consistently performed in clinical practice. Further research is needed to better understand the system-level factors driving this variability and to inform strategies for improving fidelity to the TLT process.