好色先生

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Abstract Details

Clinicians’ Goals-of-care Communication Patterns for Critically Ill Neurologic Patients: A Pilot Multi-center Qualitative Study
Neuro Trauma, Critical Care, and Sports Neurology
S48 - Neurocritical Care: Traumatic Brain Injury and Goals-of-care Decision-making (1:48 PM-2:00 PM)
005
To characterize the patterns by which clinicians address key aspects of goals-of-care communication for patients with severe neurologic injury.
End-of-life research in general critical care has revealed that clinician-family communication breakdown is common, but this has not been studied for patients with severe neurologic injury. Understanding physicians’ real-life goals-of-care communication patterns for patients with severe neurologic injury may help identify targets for improvement.
We audiorecorded 35 goals-of-care clinician-family meetings for 31 patients with severe neurologic injury at seven U.S. academic medical centers. We used both deductive and inductive constant comparative methods to develop a coding framework characterizing goals-of-care communication patterns, which two coders independently applied to the transcripts (kappa=0.86).
The clinician-family meetings were led by 27 clinicians from 9 specialties with an average 13-year post-graduate practice duration. The most common physician-initiated attributes of goals-of-care communication were: Disclosing prognosis (89% of all meetings), discussing treatment decisions (51%), eliciting patient’s values and preferences (51%), and making recommendations (46%).

We found several patterns of GOC communication: Recommending treatment prior to discussing patient preferences (29% of all meetings); Prognostic statements with no discussion of preferences assuming life-prolonging care (29%); beginning with prognostic disclosure before eliciting preferences (31%); and eliciting treatment preferences first followed by prognostic disclosure (11%). In 88% of all clinician-family meetings, clinicians disclosed prognosis first before eliciting treatment preferences, or even omitted such preference-elicitation completely.

Nearly half of clinicians did not elicit treatment preferences, despite the known importance of doing so for serious illness communication. By identifying clinicians’ real-life goals-of-care communication patterns, we can next examine their possible associations with quantified measures of quality-of-communication and determine important targets for interventions to improve clinician-family goals-of-care communication for patients with severe neurologic injury.
Authors/Disclosures
Connie Ge, MD
PRESENTER 		Ms. Ge has nothing to disclose.
Adeline L. Goss, MD (Highland Hospital) Dr. Goss has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Neurological Association.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Douglas White, MD No disclosure on file
Susanne Muehlschlegel, MD, MPH, FAAN (Johns Hopkins School of Medicine) Dr. Muehlschlegel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Acasti Pharma Inc.. Dr. Muehlschlegel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acasti Pharma Inc.. The institution of Dr. Muehlschlegel has received research support from NIH. The institution of Dr. Muehlschlegel has received research support from NIH. The institution of an immediate family member of Dr. Muehlschlegel has received research support from NIH. The institution of Dr. Muehlschlegel has received research support from Johns Hopkins Stimulating and Advancing Anesthesiology & Critical Care Medicine Research (StAAR) Award. The institution of Dr. Muehlschlegel has received research support from Trustees of The Patrick and Catherine Weldon Donaghue Medical Research Foundation. The institution of Dr. Muehlschlegel has received research support from Harkin Family Fund (Johns Hopkins Dept. of Neurology). Dr. Muehlschlegel has received personal compensation in the range of $500-$4,999 for serving as a Speaker and Author with 好色先生. Dr. Muehlschlegel has a non-compensated relationship as a Member of Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities.