好色先生

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Abstract Details

Shared decision-making in goals-of-care meetings for critically ill neurologic patients: A multi-center study.
Neuro Trauma, Critical Care, and Sports Neurology
S26 - Neurocritical Care (2:24 PM-2:32 PM)
003
To characterize and quantify shared decision-making (SDM) elements during real-life clinician-family meetings for critically-ill neurologic patients (CINPs).
SDM has been recommended by the Institute of Medicine and several critical care societies to improve difficult decisions in the intensive care unit (ICU). Yet, for goals-of-care (GOC) decisions, considered the most difficult decision of all, empiric research in medical-surgical ICUs showed that only 2% of GOC clinician-family meetings contained all elements of SDM. This figure remains unknown for patients in neuroICUs. Understanding and quantifying SDM elements in GOC meetings for CINPs may help identify targets for improvement. 
We applied a validated 10-element SDM instrument to 27 goals-of-care clinician-family meetings for CINPs audiorecorded at seven U.S. academic medical centers. Two independent coders doubled-coded 16 transcripts, achieving an inter-rater reliability of >85%. Subsequently, 11 transcripts were single-coded.
The SDM score (total number of unique SDM elements present per meeting) ranged between 0 to 10 (mean 5.85; SD 2.5; max = 10). Only 3% of meetings contained all 10 SDM elements. The proportion of meetings containing each SDM element is as follows: “Discuss the nature of the decision” (56%); “Describe treatment alternatives” (59%); “Discuss the pros and cons of the choices” (52%); “Discuss uncertainty” (81%); “Assess family understanding” (78%); “Elicit patient values and preferences” (74%); “Discuss the family’s role in decision making” (48%); “Assess the need for input from others” (26%); “Explore the context of the decision” (74%); “Elicit the context of the decision” (37%).

Only a small proportion of clinician-family GOC meetings for CINPs contained all elements of SDM. We uncovered notable gaps in clinicians asking for input from others and providing the pros and cons of each decision, which are crucial elements of SDM. Evidence-based interventions to increase SDM for GOC decisions in critically ill neurologic patients are urgently needed. 
Authors/Disclosures
Abhinav V. Prasad
PRESENTER 		Mr. Prasad has nothing to disclose.
Connie Ge, MD Ms. Ge has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
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.