Table 2.

Types of treatment trials presented by physicians in ICU family conferences

Time-limited Trial
Description	The option of continuing all intensive, life-sustaining treatments, with a plan to reassess the appropriateness of this treatment and the goals of care after a defined period of time based on pre-specified clinical milestones.
Example	An elderly patient with chronic lung disease has acute respiratory failure. The physician offers a plan to continue aggressive ICU care for four days to assess whether there will be an improvement in lung function, with a suggestion to reconsider goals if there is no clinical improvement.
Representative quotes	That’s … that would be my recommendation … is that we do what’s called a time-limited trial, where we say you know, “We’re gonna do everything we can, for the next 48 hours” and, if she’s not getting better, that means she’s getting worse… And at that point, we should probably withdraw the ventilator and let her die.
	Another option to kinda go from here, is to just say, you know, “We think he’s doing ok. We really want him to get better, but we are also not sure which direction it’s going and we want to wait and talk again in two weeks …” or pick a certain amount of time and we just call that like a time-limited trial and we see how he does over the next few weeks and we sit down again and say, “Boy it looks like things are going better …” Or, we say, “things are the same or getting worse and maybe we need to talk about different goals.”
Symptom-limited Trial
Description	The option of using basic medical care aimed at survival (rather than purely comfort-oriented treatment) once ventilatory support is withdrawn, with a plan to reassess the appropriateness of this treatment and the goals of care based on patient symptoms.
Example	A patient with metastatic lung cancer is on mechanical ventilation for respiratory failure. The physician presents a plan to extubate with the hope that the patient will be able to breathe on his own. If the patient is able to tolerate this with minimal symptoms, medical treatments aimed at survival will be continued (e.g., antibiotics, oxygen, nutrition/hydration). If the patient is not able to tolerate this because of symptoms, then there would be an option of transitioning to purely comfort-oriented treatment.
Representative quotes	And that’s sort of another thing we want to address. Our hope is that when we remove the tube, he’s able to breathe ok. But, if he has trouble breathing and goes into distress with that, we would want to do things to make him more comfortable.
	even if we turn the ventilator off, took her breathing tube out, I think she would actually do fine for a while. The question is, what happens if, two weeks from now, she’s the same, in terms of her mental status and she aspirates something and develops another infection. At that point, would she want to get another breathing tube in, more antibiotics, more interventions? Or would she rather take this window of opportunity to maybe sort of make sure that these next two weeks or so are centered more around her being comfortable and family around and all this.