Prognostic Discussion for Infants with Neurologic Conditions: Qualitative Analysis of Family Conferences.

Abstract

We characterize the content and role of prognostic discussion for infants with neurologic conditions. In this descriptive qualitative study, we prospectively enrolled infants (age < 1 year) in the intensive care unit with a neurologic condition anticipated to have ≥1 family conference about prognosis or goals of care. We audiorecorded family conferences as they occurred. We used a rapid-cycle qualitative approach to identify and refine themes. Forty infants and 61 parents were enrolled; 68 family conferences occurred for 24 infants. The majority of infant cases (n=23/24, 96%) and conferences (n=64/68, 94%) included discussion of neurologic prognosis. Common infant diagnoses included prematurity (n=12, 52%), genetic conditions (n=9, 35%), and brain malformations (n=7, 30%). We identified 2 themes relating to the characterization of the infant's prognosis: (1) predictions of impairment and (2) rationale for prognostic predictions. We identified 3 themes characterizing the role of prognostic discussion: (1) aligning parent and clinician understanding of infant outcome, (2) influencing decision-making, and (3) preparing for life at home. We identified 2 themes characterizing discussion of prognostic uncertainty: (1) multilayered types of uncertainty and (2) holding space for hope alongside uncertainty. In this cohort of infants with neurologic conditions and their parents, we identified salient themes characterizing the content and role of discussion about neurologic outcome. Our findings highlight that prognostic discussion focuses on anticipated impairments, informs decision-making, and helps families prepare for home life. Future work should characterize whether these findings align with parent preferences for prognostic disclosure. ANN NEUROL 2022;92:699-709.