Finding Your Voice.

Area of Science:

• Neurology
• Clinical Medicine
• Patient Advocacy

Background:

• Guillain Barre Syndrome (GBS) can cause profound communication deficits, even when cognitive function remains intact.
• This frequently necessitates surrogate decision-making for goals-of-care, potentially misrepresenting patient autonomy.
• Effective communication strategies are crucial for respecting patient wishes in GBS.

Purpose of the Study:

• To illustrate a case where a patient with GBS, despite progressive communication loss, successfully articulated her goals-of-care.
• To emphasize the importance of identifying and utilizing patient-specific communication methods.
• To advocate for patient-centered communication in critical care settings.

Main Methods:

• Case report of a patient diagnosed with Guillain Barre Syndrome.
• Documentation of the patient's progressive communication impairments, including dysarthria, hypophonia, and intubation.
• Observation and description of the methods used by the patient to express her wishes regarding goals-of-care.

Main Results:

• The patient, initially unable to speak due to GBS, progressively lost her voice.
• Despite intubation, the patient found alternative methods to communicate her specific goals-of-care.
• The patient's autonomy was ultimately respected through her expressed wishes.

Conclusions:

• Even with severe neurological impairment and intubation, patients with GBS can communicate critical goals-of-care information.
• Healthcare providers must remain vigilant in seeking and facilitating patient communication.
• Upholding patient autonomy requires tailored communication approaches in complex neurological conditions.