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Prognostic Language in Critical Neurologic Illness: A Multicenter Mixed-Methods Study
Adeline Goss1, Connie Ge2, Sybil Crawford1
1From the Division of Neurology (A.G.), Department of Internal Medicine, Highland Hospital, Oakland, CA; Department of Neurology (C.G., K.G.), and Tan Chingfang Graduate School of Nursing (S. Crawford), University of Massachusetts Chan Medical School, Worcester; Department of Critical Care Medicine (P.B., D.B.W.), University of Pittsburgh School of Medicine, PA; Division of Pulmonary, Allergy, and Critical Care Medicine (C.L.H.), Department of Medicine, Oregon Health & Science University, Portland; Department of Medicine (B.L.), University of California San Francisco; Division of Pulmonary and Critical Care Medicine (S. Carson), Department of Medicine, University of North Carolina Hospitals, Chapel Hill; Division of Pulmonary Medicine and Critical Care Medicine (J.S.), Department of Internal Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield; and Departments of Neurology, Anesthesia/Critical Care, and Surgery (S.M.), University of Massachusetts Chan Medical School, Worcester.
Clinicians rarely used estimates when discussing prognosis for critical neurologic illness, particularly for cognitive outcomes. This study highlights a gap in evidence-based guidelines for prognostic communication in critical care neurology.
Area of Science:
- Neurology
- Critical Care Medicine
- Medical Communication
Background:
- Evidence-based guidelines for discussing prognosis in critical neurologic illness are lacking.
- Experts recommend using estimates (numerical or qualitative) for prognostic communication.
- Real-world clinician practices in communicating prognosis for critical neurologic illness are not well understood.
Purpose of the Study:
- To characterize the prognostic language used by clinicians in critical neurologic illness.
- To explore differences in prognostic language across various prognostic domains (e.g., survival, cognition).
Main Methods:
- A multicenter, cross-sectional, mixed-methods study analyzed audio-recorded clinician-family meetings for critically ill neurologic patients.
- Prognostic statements were coded for language type (probabilistic vs. nonprobabilistic) and domain (survival, physical function, cognition, overall recovery).
- Statistical analysis, including logistic regression, examined associations between prognostic language and domain.
Main Results:
- Most prognostic statements (62%) were nonprobabilistic; only 2% offered numeric estimates.
- Statements about survival and physical function were more frequently probabilistic than those about cognition.
- Prognostic language varied by domain, with cognitive outcomes least likely to be discussed using probabilistic terms.
Conclusions:
- Clinicians tend to avoid using estimates when communicating prognosis in critical neurologic illness, especially concerning cognitive outcomes.
- Findings suggest a need for interventions to improve prognostic communication in this patient population.
