Prognosis Predictions by Families, Physicians, and Nurses of Patients with Severe Acute Brain Injury: Agreement and Accuracy

Kiker, Whitney A; Voumard, Rachel Rutz; Plinke, Wesley; Longstreth, W. T.; Curtis, J. Randall; Creutzfeldt, Claire J.

doi:10.1007/s12028-022-01501-7

Cited by 4 publications

(2 citation statements)

References 33 publications

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“…Many studies have found that, when asked, surrogates report believing different prognoses than clinicians report having communicated. 96,97 Those differences may unclear clinician communications or surrogates receiving different clear messages from different members of the medical team. 62 Such confusion can add to surrogates' stress, reduce the quality of SDM interactions, and increase skepticism about clinicians' ability to prognosticate.…”

Section: Surrogate Decision Makingmentioning

confidence: 99%

Cognitive Biases and Shared Decision Making in Acute Brain Injury

Steinberg,

Fischhoff

2023

Semin Neurol

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Many patients hospitalized after severe acute brain injury are comatose and require life-sustaining therapies. Some of these patients make favorable recoveries with continued intensive care, while others do not. In addition to providing medical care, clinicians must guide surrogate decision makers through high-stakes, emotionally charged decisions about whether to continue life-sustaining therapies. These consultations require clinicians first to assess a patient's likelihood of recovery given continued life-sustaining therapies (i.e., prognosticate), then to communicate that prediction to surrogates, and, finally, to elicit and interpret the patient's preferences. At each step, both clinicians and surrogates are vulnerable to flawed decision making. Clinicians can be imprecise, biased, and overconfident when prognosticating after brain injury. Surrogates can misperceive the choice and misunderstand or misrepresent a patient's wishes, which may never have been communicated clearly. These biases can undermine the ability to reach choices congruent with patients' preferences through shared decision making (SDM). Decision science has extensively studied these biases. In this article, we apply that research to improving SDM for patients who are comatose after acute brain injury. After introducing SDM and the medical context, we describe principal decision science results as they relate to neurologic prognostication and end-of-life decisions, by both clinicians and surrogates. Based on research regarding general processes that can produce imprecise, biased, and overconfident prognoses, we propose interventions that could improve SDM, supporting clinicians and surrogates in making these challenging decisions.

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Section: Surrogate Decision Makingmentioning

confidence: 99%

Cognitive Biases and Shared Decision Making in Acute Brain Injury

Steinberg,

Fischhoff

2023

Semin Neurol

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“…[4][5][6][7] Families often express more optimistic predictions for recovery due to beliefs in their loved ones' resilience and personal strengths, at times in contrast to clinicians' possibly less optimistic perspectives on patient outcomes. [8][9][10][11] The practical significance and gravity of such discordance are underscored by the reality that weighty decisions to continue, withhold, or withdraw life-sustaining treatments are often predicated on expectations surrounding the likelihood and degree to which consciousness will recover after severe brain injury. [12][13][14] Because of the central role that consciousness and its potential for recovery plays in medical decision-making and discussions surrounding patients with disorders of consciousness, reconciling discordant perspectives about a patient's state of consciousness, potential for recovery, and the worthwhileness of life-sustaining treatment necessitates critical exploration of how consciousness is defined, operationalized, and valued by different stakeholder groups across clinical settings.…”

mentioning

confidence: 99%

Disambiguating Consciousness in Clinical Settings

Choi,

Young

2023

Neurology

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Patients affected by severe brain injury can experience complex states of disordered consciousness. These include the comatose state, characterized by a complete loss of spontaneous or stimulus-induced wakefulness and awareness; the vegetative state/unresponsive wakefulness syndrome, in which patients can be awake but exhibit no signs of conscious perception or deliberate action; the minimally conscious state, characterized by low-level awareness of self or environment; and the acute confusional state, which entails the recovery of wakefulness and awareness with persistent confusion.1,2 Patients with acute brain injuries may move unpredictably between these states and often evade precise and accurate assessment due to limitations in assessment techniques and patient-specific factors masking expression of consciousness.3

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