Prognostic Discordance Among Parents and Physicians Caring for Infants with Neurologic Conditions

Abstract

To determine the frequency, degree, and nature of prognostic discordance between parents and physicians caring for infants with neurologic conditions. In this observational cohort study, we enrolled parents and physicians caring for infants with neurologic conditions in advance of a family conference. Parent-physician dyads completed a postconference survey targeting expected neurologic outcomes across 3 domains (motor, speech, and cognition) using a 6-point scale. Prognostic discordance was defined as a difference of ≥2 response options and was considered moderate (difference of 2-3 response options) or high (difference of 4-5 response options). Responses were categorized as differences in belief and/or differences in understanding using an existing paradigm. Forty parent-physician dyads of 28 infants completed surveys. Parent-physician discordance about prognosis occurred in ≥1 domain in the majority of dyads (n=28/40, 70%). Discordance was generally moderate in degree (n=23/28, 82%) and occurred with similar frequency across all domains. Of parent-physician dyads with discordance, the majority contained a difference in understanding in at least 1 domain (n=25/28, 89%), while a minority contained a difference of belief (n=6/28, 21%). When discordance was present, parents were typically more optimistic in their predictions compared with physicians (n=25/28, 89%). Differing perceptions about the prognosis of critically ill infants are common and due to differences in both understanding and belief. These findings can be used to develop targeted interventions to improve prognostic communication.