Coaching doctors to improve ethical decision-making in adult hospitalised patients potentially receiving excessive treatment: Study protocol for a stepped wedge cluster randomised controlled trial.

BACKGROUND: Fast medical progress poses a significant challenge to doctors, who are asked to find the right balance between life-prolonging and palliative care. Literature indicates room for enhancing openness to discuss ethical sensitive issues within and between teams, and improving decision-making for benefit of the patient at end-of-life. METHODS: Stepped wedge cluster randomized trial design, run across 10 different departments of the Ghent University Hospital between January 2022 and January 2023. Dutch speaking adult patients and one of their relatives will be included for data collection. All 10 departments were randomly assigned to start a 4-month coaching period. Junior and senior doctors will be coached through observation and debrief by a first coach of the interdisciplinary meetings and individual coaching by the second coach to enhance self-reflection and empowering leadership and managing group dynamics with regard to ethical decision-making. Nurses, junior doctors and senior doctors anonymously report perceptions of excessive treatment via the electronic patient file. Once a patient is identified by two or more different clinicians, an email is sent to the second coach and the doctor in charge of the patient. All nurses, junior and senior doctors will be invited to fill out the ethical decision making climate questionnaire at the start and end of the 12-months study period. Primary endpoints are (1) incidence of written do-not-intubate and resuscitate orders in patients potentially receiving excessive treatment and (2) quality of ethical decision-making climate. Secondary endpoints are patient and family well-being and reports on quality of care and communication; and clinician well-being. Tertiairy endpoints are quantitative and qualitative data of doctor leadership quality. DISCUSSION: This is the first randomized control trial exploring the effects of coaching doctors in self-reflection and empowering leadership, and in the management of team dynamics, with regard to ethical decision-making about patients potentially receiving excessive treatment.

Comparing artificial intelligence and human coaching goal attainment efficacy.

The history of artificial intelligence (AI) is filled with hype and inflated expectations. Notwithstanding, AI is finding its way into numerous aspects of humanity including the fast-growing helping profession of coaching. Coaching has been shown to be efficacious in a variety of human development facets. The application of AI in a narrow, specific area of coaching has also been shown to work. What remains uncertain, is how the two compare. In this paper we compare two equivalent longitudinal randomised control trial studies that measured the increase in clients' goal attainment as a result of having received coaching over a 10-month period. The first study involved human coaches and the replication study used an AI chatbot coach. In both studies, human coaches and the AI coach were significantly more effective in helping clients reach their goals compared to the two control groups. Surprisingly however, the AI coach was as effective as human coaches at the end of the trials. We interpret this result using AI and goal theory and present three significant implications: AI coaching could be scaled to democratize coaching; AI coaching could grow the demand for human coaching; and AI could replace human coaches who use simplistic, model-based coaching approaches. At present, AI's lack of empathy and emotional intelligence make human coaches irreplicable. However, understanding the efficacy of AI coaching relative to human coaching may promote the focused use of AI, to the significant benefit of society.