Ethical implications of detecting cognitive motor dissociation early after brain injury (P4-7.005)

Abstract

<h3>Objective:</h3> To determine the impact of cognitive motor disassociation (CMD) in goals of care (GOC) decisions for surrogate decision makers and healthcare professionals (HCPs) of unconscious patients and assess support for clinical research participation. <h3>Background:</h3> Predictions of recovery from acute disorders of consciousness are imprecise but novel diagnostic tools are emerging. CMD refers to the detection of willful brain activation following motor commands in the absence of behavioral command following as detected by machine learning-supported EEG or MRI analysis. This phenomenon has been identified as a predictor of long-term recovery but acceptance of technology-supported prognostication by surrogates and HCPs remains uncertain. <h3>Design/Methods:</h3> We recruited surrogates and HCPs caring for unconscious patients with intracerebral hemorrhage. All participants completed a thirteen-item survey that captured data on demographics, education, religiosity, support for research participation, and receptiveness to technology-assisted prognostication in decision-making. <h3>Results:</h3> A total of 134 participants completed the survey, including 85 HCPs (40 physicians/PAs, 45 RNs) and 49 surrogates. There were no differences in sex between the two groups (67% of HCPs and 61% of surrogates were female). Surrogates reported stronger religious affiliation with 73% indicating religion was “very important” or “the most important part” of their life vs. 29% of HCPs. Both surrogates (73%) and HCPs (93%) indicated a diagnosis of CMD would help in decision-making. There was broad support for clinical trial participation in surrogates (86%) and HCPs (89%). HCPs were more likely than surrogates to change their goals if CMD could not be detected (OR 5.5, 95%-CI 2.4–12.7, p=0.00005). There was only a trend for a higher chance of HCPs to change their goals if CMD could be detected when compared to surrogates (OR 1.9, 95%-CI 0.9–3.8, p=0.08). <h3>Conclusions:</h3> These results demonstrate acceptance of technology-supported prognostication amongst HCPs and surrogate decision-makers. Targeted education to interpret detection and failure of detection of CMD is needed. <b>Disclosure:</b> Mr. Heinonen has nothing to disclose. Miss Carmona has nothing to disclose. Kevin Doyle has nothing to disclose. Ms. Grobois has nothing to disclose. Miss Kruger has nothing to disclose. Dr. Velazquez has nothing to disclose. Ms. Vrosgou has nothing to disclose. Dr. Shen has nothing to disclose. Mrs. Cespedes has nothing to disclose. Ms. Yazdi has nothing to disclose. Dr. Ghoshal has nothing to disclose. Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals. Dr. Agarwal has nothing to disclose. Dr. Park has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical Care. The institution of Dr. Park has received research support from National Institutes of Health. The institution of Dr. Dugdale has received research support from McDonald Agape Foundation. Dr. Dugdale has received publishing royalties from a publication relating to health care. Dr. Dugdale has received publishing royalties from a publication relating to health care. Dr. Dugdale has received personal compensation in the range of $500-$4,999 for serving as a Speaking honoraria for various lectures with Multiple organizations. Dr. Claassen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Claassen has stock in iCE Neurosystems. The institution of Dr. Claassen has received research support from NINDS. The institution of Dr. Claassen has received research support from McDonnel Foundation. Dr. Claassen has received publishing royalties from a publication relating to health care. Dr. Claassen has received publishing royalties from a publication relating to health care.