Assessment of Discordance Between Physicians and Family Members Regarding Prognosis in Patients With Severe Acute Brain Injury

• DOI: 10.1001/jamanetworkopen.2021.28991
• Publication Date: 2021-10-21T16:41:15Z
• Authors: Whitney A. Kiker; Rachel Rutz Voumard; Leah I. B. Andrews; Robert G. Holloway; Lyndia C. Brumback; Ruth A. Engelberg; J. Randall Curtis; Claire J. Creutzf...
• Keywords: Male; Aged; Brain Injuries/complications; Cross-Sectional Studies; Dissent and Disputes; Family/psychology; Female; Humans; Male; Middle Aged; Physicians/psychology; Physicians/statistics & numerical data; Prognosis; Middle Aged; Prognosis; Dissent and Disputes; 3. Good health; Cross-Sectional Studies; Brain Injuries; Physicians; Humans; Family; Female; Original Investigation; Aged

<h3>Importance</h3> Shared decision-making requires key stakeholders to align in perceptions of prognosis and likely treatment outcomes. <h3>Objective</h3> For patients with severe acute brain injury, the objective this study was better understand discordance between physicians families by determining prevalence associated factors. <h3>Design, Setting, Participants</h3> This mixed-methods cross-sectional analyzed a cohort collected from January 4, 2018, July 22, 2020. conducted medical cardiac intensive care units single neuroscience center. Participants included families, physicians, nurses admitted injury. <h3>Exposures</h3> Severe injury defined as stroke, traumatic or hypoxic ischemic encephalopathy Glasgow Coma Scale score less than equal 12 points after hospital day 2. <h3>Main Outcomes Measures</h3> Prognosis 20% greater difference family physician predictions; misunderstanding prediction family's estimate prediction; optimistic belief any (&gt;0%) their prediction. Logistic regression used identify associations discordance. Optimistic differences were subgroup <h3>Results</h3> Among 222 enrolled patients, prognostic predictions available for 193 (mean [SD] age, 57 [19] years; 106 men [55%]). occurred 118 (61%) significantly more common among who identified minoritized racial groups compared White (odds ratio [OR], 3.14; CI, 1.40-7.07,<i>P</i> = .006); siblings (OR, 4.93; 95% 1.35-17.93,<i>P</i> .02) adult children 2.43; 1.10-5.37;<i>P</i> .03) spouses; when perceived understanding poor good 3.73; 1.88-7.40;<i>P</i> &lt; .001). Misunderstanding present 80 173 (46%) evaluated type discordance, 94 (54%). In qualitative analysis, faith uncertainty emerged themes underlying differences. Nurse perception 2.06; 1.07-3.94;<i>P</i> .03), 2.32; 1.10-4.88;<i>P</i> .03). <h3>Conclusions Relevance</h3> Results suggest that common. Efforts improve communication should aim reduce find ways target both