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Abstract Details

The Power of Words: The Use of Nudging Language in Neurocritical Care Unit Goals of Care Discussions
Neuro Trauma and Critical Care
P7 - Poster Session 7 (8:00 AM-9:00 AM)
18-007
To determine the frequency and patterns of nudging language during goals of care discussions in the neurocritical care unit (NCCU). 
Nudging language refers to subtle phrases, cues, or framing that influences how choices are perceived by listeners. In the NCCU, clinician-led goals of care discussions guide patient surrogates in navigating complex treatment decisions. The use of nudging language in these discussions, which may shape how surrogates decide to initiate, continue, or discontinue life-sustaining treatments, remains unexplored.

Fifty-three de-identified transcripts from audio-recorded clinician-family meetings at two different centers, collected from an ongoing multi-center, observational study, were qualitatively analyzed. Unique decision points within each transcript were identified and recorded by two coders (e.g., placement of a tracheostomy or withdrawal of life-sustaining therapy). Next, transcripts were parallel-coded for instances of nudging language using a previously-published framework. Nudges were classified into: salience, framing (further sub-typed as positive, negative, or mixed), options, default, endowment, commission, omission, recommendation, expert opinion, certainty, and social norms. Discrepancies in coding were resolved through discussion. 
Across fifty-three meetings, we identified nudging language in 74% (39/53) of the transcripts. The total number of unique nudges was 202, with a median of 3.5 [3.0-5.0] nudges per transcript. The most common types of nudges were Negative Framing (present in 26/53 family meetings; 49%) e.g. "Most people who go to the nursing home don't survive long there"; Options (26/53 family meetings; 49%) e.g., "We have two pathways"; Recommend (15/53 family meetings; 28%) e.g., "We would recommend not to code him"; and Certainty (9/53 family meetings; 17%) e.g., "He will code within 24-48 hours." 
Preliminary findings suggest that nudging language is very commonly used in NCCU goals of care discussions. Ongoing analysis will examine over 50 additional transcripts to further explore communication patterns and the potential implications for surrogate decision-making.
Authors/Disclosures
Miriam Quinlan, MD, MPH
PRESENTER 		Dr. Quinlan has nothing to disclose.
Celine Arar, Medical Student Ms. Arar has nothing to disclose.
Winnie Liu Ms. Liu has nothing to disclose.
Michaela Bostwick Ms. Bostwick has nothing to disclose.
Eleni Panagopoulos, BA Ms. Panagopoulos has nothing to disclose.
Joanna Hart, MD An immediate family member of Dr. Hart has received personal compensation for serving as an employee of Mastery Charter Schools. An immediate family member of Dr. Hart has received personal compensation for serving as an employee of Society Hill Synagogue. The institution of Dr. Hart has received research support from National Institutes of Health. The institution of Dr. Hart has received research support from Patient Centered Outcomes Research Institute.
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.