Strategies to Derive and Disclose Prognosis in Critically Ill Neurologic Patients

Primary Investigator (UMASS): Susanne Muehlschlegel, MD MPH

Design: Prospective, outcome study

Objectives:  (1) characterize strategies which clinicians use to disclose and communicate prognostic information to surrogates of critically-ill neurologic patients (CINP); (2) describe variability of communication during routine clinician-family conferences for CINP in ICUs; (3) characterize the quality of communication and family-perceived family-centeredness using validated scales; (4) quantify the prognostic concordance between surrogate decision-makers and other family members and clinicians  after the routine clinician-family conferences for CINP.

We plan to achieve these objectives by (1) audiorecording routine clinician-family conferences for CINP and subsequently perform qualitative analyses; (2) analyzing de-identified transcripts of clinician-family conferences with families of critically ill patients with a neurological diagnosis from a different study not conducted at UMass (Univ of Pittsburgh); (3) administer validated scales to surrogate decision makers and other family members who were present during the audiorecorded clinician-family conference to assess quality of communication and family-perceived family-centeredness; (4) elicit quantitative prognostic estimates from clinicians and surrogates after the clinician-family conferences; (5) obtain baseline characteristics from the surrogate decision makers and other family members who were present during the audiorecorded clinician-family conference and the CINP in order to employ multivariable methods to identify strategies that convey prognostic information with high or low prognostic concordance.

Anticipated study duration: Four years (until 2020-2024)

Anticipated patient enrollment: Approximately 175 family meeting interactions will be recorded

UMASS IRB docket number: H00016916