The following is a summary of “Prevalence and predictors of shared decision-making in goals-of-care clinician-family meetings for critically ill neurologic patients: a multi-center mixed-methods study,” published in the October 2023 issue of Critical Care by Fleming et al.

Shared decision-making is a collaborative approach to healthcare where patients and clinicians make informed choices together. Researchers started a retrospective study to determine the prevalence and predictors of shared decision-making in goals-of-care discussions for critically ill neurologic patients.

They examined 72 recorded clinician-family meetings that discussed goals of care in seven US hospitals. These meetings involved 67 patients with 72 surrogates and 29 clinicians, with one hospital responsible for 68% (49/72) of the recordings. A validated 10-element tool gauged shared decision-making in each meeting. Post-meeting surveys collected data on clinician and surrogate characteristics, patient hospital survival, and 6-month independent function prognostics. Clinician-family prognostic discordance (≥20% difference) was computed. Mixed-effects regression pinpointed factors linked to enhanced shared decision-making.

The results showed a median shared decision-making score of 7 (with an interquartile range of 5-8). Merely 6% of the meetings encompassed all 10 shared decision-making elements. “Discussing uncertainty” (89%) and “assessing family understanding” (86%) were common, whereas “assessing the need for input from others” (36%) and “eliciting the context of the decision” (33%) were infrequent. Clinician-family prognostic discordance was 60% for hospital survival and 45% for 6-month independent function. Younger clinicians with less experience and worked in medical-surgical critical care were more likely to engage in shared decision-making, especially when they and the family disagreed on the patient’s prognosis. Only when clinicians and families disagreed on the patient’s prognosis was shared decision-making more likely. (P=0.029).

They conclude that shared decision-making is rare in goals-of-care discussions for critically ill neurological patients, suggesting interventions are needed to promote this practice.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04693-2