PROGNOSTIC INTERPRETATION BY FAMILY MEMBERS OF PEOPLE WITH COPD ON HOME OXYGEN

Abstract

SESSION TITLE: Palliative Care and End-of-Life Issues Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Variability in how healthcare proxies of Intensive Care Unit (ICU) patients interpret prognostic statements poses a challenge to informed decision making for their loved one. Variability persists when ICU proxies are asked to interpret generic prognostic statements that do not refer to their family member, in both numeric (using a percentage to describe survival) and non-numeric formats. ICU proxies also suffer from anxiety, depression, sleep disturbance, and anticipatory grief, all of which can affect how they interpret prognostic information. We investigated whether a similar pattern of variable interpretation of prognosis occurs in family members of patients at risk for critical illness in the future, who are not currently experiencing the acute stress of a loved one’s ICU stay. METHODS: We conducted an online survey of spouses, adult children, and siblings of people living with COPD on home oxygen, a group at risk for critical illness. Participants were randomly shown 3 of 16 written prognostic statements (Figure 1) in the format “If a doctor says X, what does that mean to you?” The instructions specified that each statement was a phrase a doctor might use when speaking with a hypothetical patient’s family. Participants were then asked to interpret the meaning of the statements using a previously validated 0%-100% survival scale. A ridgeline plot and descriptive statistics were generated for each statement. RESULTS: 302 participants completed the survey; 206 (68%) were female, 267 (88%) were white, 167 (55%) were adult children of the patient, and median age was 49 (Interquartile Range [IQR] 38-59). Figure 1 displays the distributions of interpretations for each statement. For the 3 numeric prognostic statements, median participant interpretations all showed zero percentage point differences from the physician’s statement, with an IQR < 8 percentage points. Interpretations of non-numeric statements varied substantially, with IQR’s ranging from 5 to 34 percentage points. CONCLUSIONS: In this study of family members of people with COPD on home oxygen, participants’ interpretation of direct, numeric physician prognostic statements was more precise than non-numeric statements, which showed high variability in interpretation. This occurred even though participants were not acutely stressed about their loved one’s immediate survival and were asked to consider statements unrelated to any medical problems their loved ones could be experiencing. CLINICAL IMPLICATIONS: Clinicians should be aware that variable interpretation of non-numeric prognostic statements can occur regardless of an ICU proxy’s exposure to the acute stress of having a critically ill loved one. This may be mitigated by using direct communication techniques such as including a percentage. Asking the family member about their comprehension such as with the “ask-tell-ask” technique can help ensure accurate prognosis interpretation. DISCLOSURES: No relevant relationships by Joanna Hart, source=Web Response No relevant relationships by Emma Lee, source=Web Response No relevant relationships by Ian Oppenheim, source=Web Response No relevant relationships by Alison Turnbull, source=Web Response