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Commentary
October 5, 2011

Time-Limited Trials Near the End of Life

Author Affiliations

Author Affiliations: Center for Ethics, Humanities and Palliative Care (Drs Quill and Holloway) and Departments of Medicine (Dr Quill) and Neurology (Dr Holloway), University of Rochester Medical Center, Rochester, New York.

JAMA. 2011;306(13):1483-1484. doi:10.1001/jama.2011.1413

Clinicians, patients, and families frequently face scenarios in which they must make decisions near the end of life about whether to initiate major interventions in circumstances in which the outcome is uncertain. They do not want to prematurely forgo treatments that might help, but they also may not want to risk indefinite exposure to burdensome treatments. The possibility of a time-limited trial (TLT) of treatment may provide a way forward.

A TLT is an agreement between clinicians and a patient/family to use certain medical therapies over a defined period to see if the patient improves or deteriorates according to agreed-on clinical outcomes. If the patient improves, disease-directed therapy continues. If the patient deteriorates, the therapies involved in the trial are withdrawn, and goals frequently shift more purely to palliation. If significant clinical uncertainty remains, another TLT might be renegotiated.

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