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dc.contributor.authorGe, Connie
dc.contributor.authorGoss, Adeline L.
dc.contributor.authorCrawford, Sybil L.
dc.contributor.authorGoostrey, Kelsey
dc.contributor.authorBuddadhumaruk, Praewpannarai
dc.contributor.authorShields, Anne-Marie
dc.contributor.authorHough, Catherine L.
dc.contributor.authorLo, Bernard
dc.contributor.authorCarson, Shannon S.
dc.contributor.authorSteingrub, Jay
dc.contributor.authorWhite, Douglas B.
dc.contributor.authorMuehlschlegel, Susanne
dc.date2022-08-11T08:09:04.000
dc.date.accessioned2022-08-23T16:17:09Z
dc.date.available2022-08-23T16:17:09Z
dc.date.issued2022-02-21
dc.date.submitted2022-04-08
dc.identifier.citation<p>Ge C, Goss AL, Crawford S, Goostrey K, Buddadhumaruk P, Shields AM, Hough CL, Lo B, Carson SS, Steingrub J, White DB, Muehlschlegel S. Variability of Prognostic Communication in Critically Ill Neurologic Patients: A Pilot Multicenter Mixed-Methods Study. Crit Care Explor. 2022 Feb 21;4(2):e0640. doi: 10.1097/CCE.0000000000000640. PMID: 35224505; PMCID: PMC8863127. <a href="https://doi.org/10.1097/CCE.0000000000000640">Link to article on publisher's site</a></p>
dc.identifier.issn2639-8028 (Linking)
dc.identifier.doi10.1097/CCE.0000000000000640
dc.identifier.pmid35224505
dc.identifier.urihttp://hdl.handle.net/20.500.14038/34492
dc.description.abstractIMPORTANCE: Withdrawal-of-life-sustaining treatments (WOLST) rates vary widely among critically ill neurologic patients (CINPs) and cannot be solely attributed to patient and family characteristics. Research in general critical care has shown that clinicians prognosticate to families with high variability. Little is known about how clinicians disclose prognosis to families of CINPs, and whether any associations exist with WOLST. OBJECTIVES: Primary: to demonstrate feasibility of audio-recording clinician-family meetings for CINPs at multiple centers and characterize how clinicians communicate prognosis during these meetings. Secondary: to explore associations of 1) clinician, family, or patient characteristics with clinicians' prognostication approaches and 2) prognostication approach and WOLST. DESIGN SETTING AND PARTICIPANTS: Forty-three audio-recorded clinician-family meetings during which prognosis was discussed from seven U.S. centers for 39 CINPs with 88 family members and 27 clinicians. MAIN OUTCOMES AND MEASURES: Two investigators qualitatively coded transcripts using inductive methods (inter-rater reliability > 80%) to characterize how clinicians prognosticate. We then applied univariate and multivariable multinomial and binomial logistic regression. RESULTS: Clinicians used four distinct prognostication approaches: Authoritative (21%; recommending treatments without discussing values and preferences); Informational (23%; disclosing just the prognosis without further discussions); advisory (42%; disclosing prognosis followed by discussion of values and preferences); and responsive (14%; eliciting values and preferences, then disclosing prognosis). Before adjustment, prognostication approach was associated with center (p < 0.001), clinician specialty (neurointensivists vs non-neurointensivists; p = 0.001), patient age (p = 0.08), diagnosis (p = 0.059), and meeting length (p = 0.03). After adjustment, only clinician specialty independently predicted prognostication approach (p = 0.027). WOLST decisions occurred in 41% of patients and were most common under the advisory approach (56%). WOLST was more likely in older patients (p = 0.059) and with more experienced clinicians (p = 0.07). Prognostication approach was not independently associated with WOLST (p = 0.198). CONCLUSIONS AND RELEVANCE: It is feasible to audio-record sensitive clinician-family meetings about CINPs in multiple ICUs. We found that clinicians prognosticate with high variability. Our data suggest that larger studies are warranted in CINPs to examine the role of clinicians' variable prognostication in WOLST decisions.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=35224505&dopt=Abstract">Link to Article in PubMed</a></p>
dc.rightsCopyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC- ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectbrain injuries
dc.subjectcommunication
dc.subjectcritical care
dc.subjectdecision-making
dc.subjectfamily
dc.subjectgoals
dc.subjectprognosis
dc.subjecttreatment outcome
dc.subjectDiagnosis
dc.subjectHealth Communication
dc.subjectHealth Services Administration
dc.subjectHealth Services Research
dc.subjectNervous System Diseases
dc.subjectNursing
dc.titleVariability of Prognostic Communication in Critically Ill Neurologic Patients: A Pilot Multicenter Mixed-Methods Study
dc.typeJournal Article
dc.source.journaltitleCritical care explorations
dc.source.volume4
dc.source.issue2
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1169&amp;context=gsn_pp&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/gsn_pp/164
dc.identifier.contextkey28546089
refterms.dateFOA2022-08-23T16:17:09Z
html.description.abstract<p>IMPORTANCE: Withdrawal-of-life-sustaining treatments (WOLST) rates vary widely among critically ill neurologic patients (CINPs) and cannot be solely attributed to patient and family characteristics. Research in general critical care has shown that clinicians prognosticate to families with high variability. Little is known about how clinicians disclose prognosis to families of CINPs, and whether any associations exist with WOLST.</p> <p>OBJECTIVES: Primary: to demonstrate feasibility of audio-recording clinician-family meetings for CINPs at multiple centers and characterize how clinicians communicate prognosis during these meetings. Secondary: to explore associations of 1) clinician, family, or patient characteristics with clinicians' prognostication approaches and 2) prognostication approach and WOLST.</p> <p>DESIGN SETTING AND PARTICIPANTS: Forty-three audio-recorded clinician-family meetings during which prognosis was discussed from seven U.S. centers for 39 CINPs with 88 family members and 27 clinicians.</p> <p>MAIN OUTCOMES AND MEASURES: Two investigators qualitatively coded transcripts using inductive methods (inter-rater reliability > 80%) to characterize how clinicians prognosticate. We then applied univariate and multivariable multinomial and binomial logistic regression.</p> <p>RESULTS: Clinicians used four distinct prognostication approaches: Authoritative (21%; recommending treatments without discussing values and preferences); Informational (23%; disclosing just the prognosis without further discussions); advisory (42%; disclosing prognosis followed by discussion of values and preferences); and responsive (14%; eliciting values and preferences, then disclosing prognosis). Before adjustment, prognostication approach was associated with center (p < 0.001), clinician specialty (neurointensivists vs non-neurointensivists; p = 0.001), patient age (p = 0.08), diagnosis (p = 0.059), and meeting length (p = 0.03). After adjustment, only clinician specialty independently predicted prognostication approach (p = 0.027). WOLST decisions occurred in 41% of patients and were most common under the advisory approach (56%). WOLST was more likely in older patients (p = 0.059) and with more experienced clinicians (p = 0.07). Prognostication approach was not independently associated with WOLST (p = 0.198).</p> <p>CONCLUSIONS AND RELEVANCE: It is feasible to audio-record sensitive clinician-family meetings about CINPs in multiple ICUs. We found that clinicians prognosticate with high variability. Our data suggest that larger studies are warranted in CINPs to examine the role of clinicians' variable prognostication in WOLST decisions.</p>
dc.identifier.submissionpathgsn_pp/164
dc.contributor.departmentDepartment of Surgery
dc.contributor.departmentDepartment of Anesthesia/Critical Care
dc.contributor.departmentDepartment of Graduate School of Nursing
dc.contributor.departmentDepartment of Neurology
dc.source.pagese0640


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Copyright © 2022 The Authors.
Published by Wolters Kluwer Health,
Inc. on behalf of the Society of
Critical Care Medicine.This is an
open-access article distributed under
the terms of the Creative Commons
Attribution-Non Commercial-No
Derivatives License 4.0 (CCBYNC-
ND), where it is permissible to
download and share the work provided
it is properly cited. The work
cannot be changed in any way or
used commercially without permission
from the journal.
Except where otherwise noted, this item's license is described as Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC- ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.