To determine the minimum level of recovery (LOR) deemed acceptable by surrogate decision makers and healthcare professionals (HCPs) of unconscious patients with intracerebral hemorrhage (ICH).

Prognosticating recovery of acutely brain-injured patients is imprecise but may be improving with the development of novel technology. Understanding acceptable functional outcomes and factors that influence these thresholds for families and caregivers of patients with neurological injury is critical to ensure effective communication and the delivery of goal-concordant care.

We prospectively recruited surrogates and HCPs caring for unconscious patients with ICH. Participants completed a thirteen-item survey that captured data on demographics, education, and religiosity. Respondents selected the minimum LOR they would deem acceptable one-year post-injury. Response options were adapted from the Glasgow Outcome Scale–Extended and ranged from “survival” to “full recovery.”

A total of 134 participants completed the survey, including 85 HCPs (40 physicians/PAs, 45 RNs) and 49 surrogates. The majority of participants were female (65%) and completed at least some college (93%). HCPs were more likely than surrogates to choose a higher minimum acceptable LOR (median 4 [IQR 3-5] vs 3 [IQR 2.5-5]; OR 4.1, 95%-CI 2.1-8.1, p=0.00008). Among all respondents, participants who identify as Black/African-American were less likely to choose a higher LOR (median 3 [IQR 2-4] vs 4 [IQR 3-5]; OR 0.2, 95%-CI 0.1-0.5, p=0.002). Participants who indicated religion was “the most important part” of their life were less likely to choose a higher LOR (median 3 [IQR 2-3] vs 4 [IQR 3-5]; OR 0.3, 95%-CI 0.1-0.9, p=0.032). In a multivariate model, HCP vs. surrogate status was the only significant predictor; HCPs were more likely than surrogates to choose a higher LOR ([OR 2.2, 95%-CI 1.0-4.6, p=0.048).

This study highlights the need for HCPs to recognize in goals of care discussions that surrogates find acceptable a lower LOR than do HCPs themselves.