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Abstract Details

Evidence-sharing Methods Utilized by Clinicians During Prognostication Meetings for Critically Ill Neurologic Patients
Neuro Trauma and Critical Care
S23 - Neurocritical Care (1:00 PM-1:12 PM)
001
To characterize and quantify the types of evidence-sharing utilized by clinicians when speaking with family members of Critically-Ill Neurologic Patients (CINP).
When disclosing a CINP’s prognostication to their families, clinicians employ various methods of evidence-sharing. Little is known about the types of information clinicians choose to disclose but has the potential to improve clinician-family communication and family members’ understanding of the CINP’s prognosis, which is crucial for shared decision-making.
We qualitatively analyzed 48 de-identified transcripts of audio-recorded routine clinician-family meetings concerning CINPs at a U.S. academic medical center during which prognostication was provided. We applied an existing legal framework of evidence-sharing to deductively classify different types of information-sharing. In accordance with this framework, clinician statements were classified into “Real” (conveying the current status of the CINP), “Documentary” (reference to current research and literature regarding the CINP’s care), “Demonstrative” (utilization of diagnostic modalities), and “Testimonial” (disclosure of personal experiences of the clinician) evidence. We used descriptive statistics to compare the types of evidence-sharing used to total numbers of evidence-sharing statements made. 
We identified a total of 621 statements of evidence-sharing. Across 48 transcripts, the average ratio of a specific type of evidence-sharing served as a summary measure for understanding primary communication approaches. The majority of statements were “Real” evidence statements (54%±15%) meaning, on average, clinicians dedicated more than half of their evidence-sharing statements disclosing the physical status of the CINP. “Demonstrative” (28%±18%), “Testimonial” (14%±15%) and “Documentary” (4%±6%) types of evidence sharing were less common amongst clinicians. 
Clinicians disclose information to surrogate decision makers with high variability and rarely disclose personal experiences concerning their own critically-ill family members or experiences of other families of CINP. As one way to improve shared decision-making, future research should explore associations between evidence-sharing methods and prognostic concordance between clinician and surrogate-perceived prognosis of CINP.
Authors/Disclosures
Mahimasri Kotamreddy
PRESENTER 		Ms. Kotamreddy has nothing to disclose.
Brooke Honzel Ms. Honzel has nothing to disclose.
Raphael A. Carandang, MD, FAAN (University of Massachusetts Medical School/UMASS Memorial Medical Group) Dr. Carandang has nothing to disclose.
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.