Patients with disorders of consciousness (DoC) lack decision making capacity. Their medical care spotlights a challenge for shared decision making as surrogate decision makers, often family members, must navigate the uncertainty of making care decisions on their behalf. This uncertainty is especially prominent in light of growing recognition of covert consciousness, attributable to advances in neurotechnologies that enable detection of sub-behavioral signatures of responsiveness and capacity for recovery. Prominent professional society guidelines now recommend the use of advanced neurotechnologies for some patients. Yet given a lack of concrete guidance for their integration into care, advanced neurotechnologies themselves introduce profound uncertainties to shared decision making.

Grounded theory and rapid qualitative analysis were employed to examine semi-structured interview data from 27 clinicians and 11 family members of patients with potential covert consciousness during three stages of conversation regarding the translation of advanced neurotechnologies into DoC care.

Harnessing these points of convergence and tension between clinicians and family throughout three stages of conversation, we develop a discussion guide that clinicians may use as a roadmap to support shared decision making in DoC care.