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Abstract Details

Ableist Language in Goals of Care Discussions in the Neurocritical Care Unit
Neuro Trauma and Critical Care
P8 - Poster Session 8 (8:00 AM-9:00 PM)
7-009
To explore the prevalence and phenotype of ableist language, which refers to words that reflect bias against individuals with disabilities, in goals-of-care (GoC) discussions in the Neurocritical Care Unit (NCCU). 
GoC discussions guide decisions on the intensity of life-sustaining treatments for patients in the NCCU. These discussions involve weighing potential disability outcomes and are often focused on functionality, which may risk introduction of ableist language. Clinician and family ableist language in GoC conversations remains understudied in NCCUs. 
We qualitatively analyzed 67 de-identified transcripts of audio-recorded clinician-family meetings from an ongoing single-center, observational study. Two coders developed and calibrated a codebook using deductive and inductive approaches and categorized clinician and family ableist language into 5 codes: (1)Superiority(non-disability as better); (2)Pity/Fear(disability as tragic); (3)Dehumanizing(disability as subhuman); (4)Stereotyping(people with disabilities as "brave" or people like “them”); and (5)Euphemism (indirect terms for disability). Coders double-coded all transcripts and resolved discrepancies via discussion.
Across 69 clinician-family meetings for 59 patients by 25 different clinicians, the median [IQR] physician age was 45[38-47], years in practice was 18[10-20], 95% were attending-led, and 72% female-physician led. Ableist language was present in 62%[43/69] of transcripts: Stereotyping (6.0%), Pity/Fear (20%), Euphemism (7.2%), Superiority (46%), and Dehumanizing (25%). Superiority occurred in more than double of instances among the clinicians than family members (73%[46/63] vs. 27%[17/63]) while family members used Dehumanizing language more often than clinicians (65%[20/31] vs. 35%[11/31]). The disability paradox—where people with disabilities report a higher quality of life than others expect—was described by a clinician in one transcript (1.4%[1/69]). 
Ableist language was prevalent in GoC discussions among both clinicians and families, potentially leading to biased GoC decisions. Further study should determine the influence of ableist language on withdrawal of life-sustaining treatment for patients with a disability prognosis. 
Authors/Disclosures
Winnie Liu
PRESENTER 		Ms. Liu has nothing to disclose.
Caroline Cerilli Ms. Cerilli has nothing to disclose.
Lourdes Carhuapoma, PhD, NP Dr. Carhuapoma has nothing to disclose.
Bonnielin Swenor, PhD The institution of Dr. Swenor has received research support from NIH. Dr. Swenor has received personal compensation in the range of $500-$4,999 for serving as a presenter and/or expert advisor with AHRQ, American Chemical Society, Boston Childrens, IVI, Urban Institute, Macy Foundation, NORC.
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 Grace Pharmaceuticals 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 Grace Pharmaceuticals 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. Dr. Muehlschlegel has a non-compensated relationship as a Officer of the Board of Directors with Neurocritical Care Society that is relevant to AAN interests or activities.