1. To characterize and quantify SDM in GOC meetings
2. To identify factors associated with higher SDM score
   

Two qualitative coders applied a validated 10-element SDM instrument to 63 GOC clinician-family meetings for CINPs, audio-recorded at seven U.S. medical centers. Clinicians and families completed post-meeting questionnaires assessing their own prognostic estimates. We defined the Clinician-Family-Prognostic-Discordance-Score as the difference between both estimates and prognostic discordance as ≥20% difference. We applied univariate and multivariable longitudinal regression to identify predictors of more SDM.

The median SDM score (total number of unique SDM elements per meeting) was 7 (range 1-10; IQR 5-8). Only 6% of meetings contained all 10 SDM elements. The most common SDM elements were “discussing uncertainty”(89%) and “assessing family understanding”(86%); the least frequent elements were “assessing the need for input from others”(40%) and “eliciting the context of the decision”(32%). Prognostic discordance was 60% and 45% for hospital-survival and 6-month independent functioning, respectively. In univariate analyses, more SDM was associated with female clinicians, and Cohort 2. Meetings with less clinician-surrogate survival discordance approached significance. After adjustment, there was a trend towards clinician gender being an independent predictor of more SDM(p=0.11), but none of the variables were independent predictors.