Shared Decision-Making Communication and Prognostic Misunderstanding in the ICU.

Area of Science:

• Critical Care Medicine
• Medical Communication
• Health Outcomes Research

Background:

• Surrogate misunderstanding of patient survival prognosis in the intensive care unit (ICU) is linked to adverse patient and surrogate outcomes.
• Shared decision-making (SDM) communication strategies may mitigate prognostic misunderstanding.

Purpose of the Study:

• To investigate the association between SDM-aligned communication during ICU family meetings and prognostic misunderstanding among surrogates and physicians.
• To determine if SDM-aligned communication impacts the accuracy of survival prognosis perception.

Main Methods:

• A retrospective cohort study involving 137 surrogates and 100 physicians across 13 ICUs.
• SDM-aligned communication was defined by high-quality serious illness communication behaviors during family meetings.
• Prognostic misunderstanding was measured as the discrepancy between physician and surrogate survival prognosis estimates.

Main Results:

• Overall, SDM-aligned communication was not significantly associated with reduced prognostic misunderstanding in surrogates or physicians.
• A significant decline in surrogate prognostic misunderstanding was observed post-meeting, but not for physicians.
• In a subgroup analysis, SDM-aligned communication was associated with reduced prognostic misunderstanding among surrogates with significant baseline misunderstanding.

Conclusions:

• SDM-aligned communication did not universally reduce prognostic misunderstanding in the ICU setting.
• Targeted application of SDM principles may be beneficial for surrogates with substantial pre-existing prognostic uncertainty.
• Further research is needed to optimize communication strategies for improving prognostic understanding in critical care.