Neuroanesthesia & neurocritical care
Identification of Palliative Care Needs and Mental Health Outcomes Among Family Members of Patients With Severe Acute Brain Injury
Authors' conclusion
In this prospective cohort study of patients with SABI and their families, palliative care needs were common, although agreement on needs was poor between clinicians and family members.
Study context
- Population
- Patients with severe acute brain injury (SABI) in the intensive care unit (ICU) ≥2 days with GCS ≤12, and their family members; academic hospital, Seattle, Washington, 2018–2021
- Participants
- 209 patient-family member pairs
- Exposure
- Palliative care need identified vs not identified on a 4-item checklist
- Outcome
- Family member symptoms of depression and anxiety, perception of goal-concordant care, ICU satisfaction; at 6 months psychological symptoms, decisional regret, patient functional outcome and QOL
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Palliative care needs identified and family psychological symptoms
- At least 1 need identified by family members
- 185 (88%)
- At least 1 need identified by clinicians
- 110 (53%)
- Clinician–family agreement on needs
- κ = −0.007; 52% agreement
- At least moderate anxiety or depression at enrollment (87 anxiety, 94 depression)
- 50%
- At least moderate anxiety or depression at follow-up (33 anxiety, 29 depression)
- 20%
Observational data: associations, not effects.
Further findings
Goal discordance (adjusted for patient age, diagnosis, disease severity, family race and ethnicity)
| RR (95% CI) | ||
|---|---|---|
| Clinician identification of any need203 participants · adjusted | 1.7 (1.2–2.5) | |
| 0.512Relative risk (log scale) |
Family decisional regret (adjusted) · 6 months
| Difference in means (points) (95% CI) | ||
|---|---|---|
| Clinician identification of any need144 participants · adjusted | 17 (5–29) | |
| −2002040Difference, points (linear scale) |
Family depression symptoms (Patient Health Questionnaire-2) at follow-up (adjusted) · 6 months
| Difference in means (points) (95% CI) | ||
|---|---|---|
| Family member identification of any need150 participants · adjusted | 0.8 (0.2–1.3) | |
| −1012Difference, points (linear scale) |
Perceived patient quality of life (QOL) (adjusted) · 6 months
| Difference in means (points) (95% CI) | ||
|---|---|---|
| Family member identification of any need78 participants · adjusted | −17.1 (−33.6 to −0.5) | |
| −40−20020Difference, points (linear scale) |
Original publication
Identification of Palliative Care Needs and Mental Health Outcomes Among Family Members of Patients With Severe Acute Brain Injury. JAMA Netw Open. Published 3 April 2023. doi:10.
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