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Abstract Details

Clinicians’ Early Open-ended Questions in Neurocritical Care Clinician-family Prognostication Meetings: Prevalence and Impact
Neuro Trauma and Critical Care
P7 - Poster Session 7 (8:00 AM-9:00 AM)
18-001
To explore the use of open-ended questions posed by the clinician early in the family meetings. 

Clinician listening conveys respect & may be fostered by open-ended questions, which humanizes ICU communication & supports value-congruent care. This study examined the prevalence and types of early open-ended questions (EOEQs) and their association with surrogate ratings of clinician communication quality.

We conducted a cross-sectional analysis within the ongoing multi-center INSPIRE-CINP study (Identifying Strategies to Prognosticate and Inform Relatives in Critically Ill Neurologic/Neurosurgical Patients). A total of 87 audio-recorded clinician–family meetings with post-meeting questionnaires were analyzed from three U.S. neuroICUs, involving 79 patients, 133 family members, & 32 clinicians. EOEQs posed within the first third of the transcript were qualitatively coded by three independent raters, achieving high inter-rater reliability (κ >0.9). To account for variability in meeting length & frequency, we calculated standardized proportions of EOEQ subtypes. Associations between EOEQs & communication outcomes were examined using both overall perceived quality of communication ratings (assessed with a single global question) & validated instruments (Quality of Communication [QOC] & modified Patient-Perceived Patient-Centeredness [PPPC]). Analyses employed mixed-effects models adjusted for clustering by clinician, patient, & surrogate, with covariates retained if p >0.15 in univariate testing.
Across 87 meetings, 209 EOEQs were identified (median 2 per meeting, IQR 1–3): 66% addressed family understanding, 13% the patient as a person, 13% patient wishes, & 8% family needs. In multivariable models adjusted for day of meeting after admission, patient & surrogate age, surrogate health literacy, & clustering, a higher number of EOEQs was associated with lower overall perceived communication quality (–0.4, 95% CI –0.7 to –0.15; p=0.003). No associations were observed with QOC or PPPC.
Examining EOEQs examines communication in neuroICUs. Paradoxically, more EOEQs were linked to lower surrogate ratings of overall communication quality, with no associations for QOC or PPPC. This may reflect surrogate preference for information early in meetings. 
Authors/Disclosures
Miriam Quinlan, MD, MPH
PRESENTER 		Dr. Quinlan has nothing to disclose.
Michaela Bostwick Ms. Bostwick has nothing to disclose.
Eleni Panagopoulos, BA Ms. Panagopoulos has nothing to disclose.
Winnie Liu Ms. Liu has nothing to disclose.
Celine Arar, Medical Student Ms. Arar 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 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.