ArticleCritical care explorations2022
Variability of Prognostic Communication in Critically Ill Neurologic Patients: A Pilot Multicenter Mixed-Methods Study.
Article in Critical care explorations, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Clinicians' Approaches to Prognostication After Traumatic Brain Injury and Cardiac Arrest: A Multi-Hospital, Qualitative Study.Neurocritical care · 2026Article
- Healthcare professionals' experiences of participating in withdrawing life-sustaining treatment decisions in a Chinese intensive care unit: a qualitative study.BMC medical ethics · 2025Article
- Palliative General Anesthesia at Terminal Extubation: "Go Gentle into that Good Night".Neurocritical care · 2025Article
- Development of web- and mobile-based shared decision-making tools in the neurological intensive care unit.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025Review
- Limitation of life sustaining therapy in disorders of consciousness: ethics and practice.Brain : a journal of neurology · 2024Review
- Mastering the brain in critical conditions: an update.Intensive care medicine experimental · 2024Article
- Prevalence and predictors of shared decision-making in goals-of-care clinician-family meetings for critically ill neurologic patients: a multi-center mixed-methods study.Critical care (London, England) · 2023Article
- Prognostic Language in Critical Neurologic Illness: A Multicenter Mixed-Methods Study.Neurology · 2023Article
- Racial Differences in Physicians' Shared Decision-Making Behaviors during Intensive Care Unit Family Meetings.Annals of the American Thoracic Society · 2023Article
- Prognostic Discussion for Infants with Neurologic Conditions: Qualitative Analysis of Family Conferences.Annals of neurology · 2022Article
- Factors influencing withdrawal of life-sustaining treatments in patients with severe acquired brain injuries: a scoping review.Frontiers in neurologyReview
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
importanceWithdrawal-of-life-sustaining treatments (WOLST) rates vary widely among critically ill neurologic patients (CINPs) and cannot be solely attributed to patient and family characteristics. Research in general critical care has shown that clinicians prognosticate to families with high variability. Little is known about how clinicians disclose prognosis to families of CINPs, and whether any associations exist with WOLST.
objectivesPrimary: to demonstrate feasibility of audio-recording clinician-family meetings for CINPs at multiple centers and characterize how clinicians communicate prognosis during these meetings. Secondary: to explore associations of 1) clinician, family, or patient characteristics with clinicians' prognostication approaches and 2) prognostication approach and WOLST. DESIGN SETTING AND
participantsForty-three audio-recorded clinician-family meetings during which prognosis was discussed from seven U.S. centers for 39 CINPs with 88 family members and 27 clinicians. MAIN OUTCOMES AND MEASURES: Two investigators qualitatively coded transcripts using inductive methods (inter-rater reliability > 80%) to characterize how clinicians prognosticate. We then applied univariate and multivariable multinomial and binomial logistic regression.
resultsClinicians used four distinct prognostication approaches: Authoritative (21%; recommending treatments without discussing values and preferences); Informational (23%; disclosing just the prognosis without further discussions); advisory (42%; disclosing prognosis followed by discussion of values and preferences); and responsive (14%; eliciting values and preferences, then disclosing prognosis). Before adjustment, prognostication approach was associated with center ( CONCLUSIONS AND RELEVANCE: It is feasible to audio-record sensitive clinician-family meetings about CINPs in multiple ICUs. We found that clinicians prognosticate with high variability. Our data suggest that larger studies are warranted in CINPs to examine the role of clinicians' variable prognostication in WOLST decisions.
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