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dc.contributor.authorQuinn, Thomas
dc.contributor.authorMoskowitz, Jesse
dc.contributor.authorKhan, Muhammad A.
dc.contributor.authorShutter, Lori
dc.contributor.authorGoldberg, Robert J.
dc.contributor.authorCol, Nananda
dc.contributor.authorMazor, Kathleen M.
dc.contributor.authorMuehlschlegel, Susanne
dc.date2022-08-11T08:11:02.000
dc.date.accessioned2022-08-23T17:29:33Z
dc.date.available2022-08-23T17:29:33Z
dc.date.issued2017-10-01
dc.date.submitted2019-04-24
dc.identifier.citation<p>Neurocrit Care. 2017 Oct;27(2):154-162. doi: 10.1007/s12028-017-0427-2. <a href="https://doi.org/10.1007/s12028-017-0427-2">Link to article on publisher's site</a></p>
dc.identifier.issn1541-6933 (Linking)
dc.identifier.doi10.1007/s12028-017-0427-2
dc.identifier.pmid28685395
dc.identifier.urihttp://hdl.handle.net/20.500.14038/50346
dc.description.abstractBACKGROUND: Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA. METHODS: We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20). RESULTS: The majority of surrogates (82%) preferred numeric estimates describing the patient's prognosis, as they felt it would increase prognostic certainty, and limit the uncertainty perceived as frustrating. Conversely, 75% of the physicians reported intentionally omitting numeric estimates during prognostication meetings due to low confidence in family members' abilities to appropriately interpret probabilities, worry about creating false hope, and distrust in the accuracy and data quality of existing TBI outcome models. Physicians felt that these models are for research only and should not be applied to individual patients. Surrogates valued compassion during prognostication discussions, and acceptance of their goals-of-care decision by clinicians. Physicians and surrogates agreed on avoiding false hope. CONCLUSION: We identified fundamental differences in the communication preferences of prognostic information between ciTBI patient surrogates and physicians. These findings inform the content of a future decision aid for goals-of-care discussions in ciTBI patients. If validated, these findings may have important implications for improving communication practices in the neurointensive care unit independent of whether a formal decision aid is used.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=28685395&dopt=Abstract">Link to Article in PubMed</a></p>
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693603/
dc.subjectCritical care
dc.subjectDecision aid
dc.subjectGoals-of-care decisions
dc.subjectQualitative research
dc.subjectShared decision making
dc.subjectSurrogate decision-maker
dc.subjectTraumatic brain injury
dc.subjectUMCCTS funding
dc.subjectCritical Care
dc.subjectHealth Communication
dc.subjectHealth Services Administration
dc.subjectNervous System Diseases
dc.subjectNeurology
dc.subjectTranslational Medical Research
dc.subjectTrauma
dc.titleWhat Families Need and Physicians Deliver: Contrasting Communication Preferences Between Surrogate Decision-Makers and Physicians During Outcome Prognostication in Critically Ill TBI Patients
dc.typeJournal Article
dc.source.journaltitleNeurocritical care
dc.source.volume27
dc.source.issue2
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/umccts_pubs/172
dc.identifier.contextkey14340531
html.description.abstract<p>BACKGROUND: Surrogate decision-makers ("surrogates") and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically ill patients. We examined surrogates' communication preferences and physicians' practices during the outcome prognostication for critically ill traumatic brain injury (ciTBI) patients in two level-1 trauma centers and seven academic medical centers in the USA.</p> <p>METHODS: We used qualitative content analysis and descriptive statistics of transcribed interviews to identify themes in surrogates (n = 16) and physicians (n = 20).</p> <p>RESULTS: The majority of surrogates (82%) preferred numeric estimates describing the patient's prognosis, as they felt it would increase prognostic certainty, and limit the uncertainty perceived as frustrating. Conversely, 75% of the physicians reported intentionally omitting numeric estimates during prognostication meetings due to low confidence in family members' abilities to appropriately interpret probabilities, worry about creating false hope, and distrust in the accuracy and data quality of existing TBI outcome models. Physicians felt that these models are for research only and should not be applied to individual patients. Surrogates valued compassion during prognostication discussions, and acceptance of their goals-of-care decision by clinicians. Physicians and surrogates agreed on avoiding false hope.</p> <p>CONCLUSION: We identified fundamental differences in the communication preferences of prognostic information between ciTBI patient surrogates and physicians. These findings inform the content of a future decision aid for goals-of-care discussions in ciTBI patients. If validated, these findings may have important implications for improving communication practices in the neurointensive care unit independent of whether a formal decision aid is used.</p>
dc.identifier.submissionpathumccts_pubs/172
dc.contributor.departmentDepartment of Surgery
dc.contributor.departmentDepartment of Anesthesiology/Critical Care
dc.contributor.departmentDepartment of Medicine
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Neurology (Neurocritical Care)
dc.source.pages154-162


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