Minimal acceptable functional outcomes according to surrogates and professionals caring for unconscious patients (P3-7.003)

Abstract

<h3>Objective:</h3> To determine the minimum level of recovery (LOR) deemed acceptable by surrogate decision makers and healthcare professionals (HCPs) of unconscious patients with intracerebral hemorrhage (ICH). <h3>Background:</h3> Prognosticating recovery of acutely brain-injured patients is imprecise but may be improving with the development of novel technology. Understanding acceptable functional outcomes and factors that influence these thresholds for families and caregivers of patients with neurological injury is critical to ensure effective communication and the delivery of goal-concordant care. <h3>Design/Methods:</h3> We prospectively recruited surrogates and HCPs caring for unconscious patients with ICH. Participants completed a thirteen-item survey that captured data on demographics, education, and religiosity. Respondents selected the minimum LOR they would deem acceptable one-year post-injury. Response options were adapted from the Glasgow Outcome Scale–Extended and ranged from “survival” to “full recovery.” <h3>Results:</h3> A total of 134 participants completed the survey, including 85 HCPs (40 physicians/PAs, 45 RNs) and 49 surrogates. The majority of participants were female (65%) and completed at least some college (93%). HCPs were more likely than surrogates to choose a higher minimum acceptable LOR (median 4 [IQR 3–5] vs 3 [IQR 2.5–5]; OR 4.1, 95%-CI 2.1–8.1, p=0.00008). Among all respondents, participants who identify as Black/African-American were less likely to choose a higher LOR (median 3 [IQR 2–4] vs 4 [IQR 3–5]; OR 0.2, 95%-CI 0.1–0.5, p=0.002). Participants who indicated religion was “the most important part” of their life were less likely to choose a higher LOR (median 3 [IQR 2–3] vs 4 [IQR 3–5]; OR 0.3, 95%-CI 0.1–0.9, p=0.032). In a multivariate model, HCP vs. surrogate status was the only significant predictor; HCPs were more likely than surrogates to choose a higher LOR ([OR 2.2, 95%-CI 1.0–4.6, p=0.048). <h3>Conclusions:</h3> This study highlights the need for HCPs to recognize in goals of care discussions that surrogates find acceptable a lower LOR than do HCPs themselves. <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.