To investigate the effectiveness of surrogate decision-maker education in the neurology wards and neuroscience ICU.

There has been little investigation into surrogate comprehension of education provided by the healthcare team.

We prospectively surveyed surrogates of patients who lacked decision-making capacity while admitted to the neurology wards or neuroscience ICU for >48 hours from 10/18-10/20. The survey investigated the surrogate’s communication with the healthcare team and understanding of the hospitalization. A member of the healthcare team was asked to indicate how well they perceived the surrogate understood the situation and provide data to facilitate calculation of the SAPS II score.

33 surrogates, 39% spouses and 30% children, agreed to participate in the study. Their loved one had been admitted for a median of 10 days (IQR 2-70) prior to survey completion. All surrogates had spoken directly to a clinician during the patient’s hospitalization, and 88% reported speaking to a clinician ≥5 times.

While half (52%) of surrogates felt their overall understanding of the hospitalization was “excellent,” 6% felt it was “poor”. The healthcare team felt that 30% of surrogates had “excellent” understanding and 10% had “poor” understanding. There was slight to no agreement between surrogate and team perception of surrogate understanding (k =0.143). With increasing acuity of illness, team perception of surrogate understanding became significantly worse (p=0.005), and self-rated understanding was non-significantly worse (p=0.074). There was no significant relationship between self or team perception of surrogate understanding and age, education, relationship, or hospitalization day.

Increasing acuity of illness is associated with worse understanding of a patient’s overall clinical picture. Additional research is needed to identify means to improve surrogate comprehension.