Respiratory failure & ventilation
Shared Decision-Making Communication and Prognostic Misunderstanding in the Intensive Care Unit (ICU)
Authors' conclusion
In this retrospective cohort study, SDM-aligned communication was not associated with changes in prognostic misunderstanding for all surrogates or physicians, but it was associated with reduced prognostic misunderstanding among surrogates with clinically significant misunderstanding at baseline.
Study context
- Population
- Surrogates of adult patients receiving prolonged mechanical ventilation, and ICU physicians, North Carolina, Pennsylvania and Washington, 2012–2017137 surrogates · 100 physicians
- Exposure
- Shared decision-making (SDM)-aligned communication during ICU family meetings and prognostic misunderstanding
- Outcome
- Postmeeting surrogate prognostic misunderstanding (absolute difference between physician's survival estimate and surrogate's perception of it; range 0-100 percentage points; ≥20 clinically significant)
- Follow-up
- Postmeeting
Methodological detailsmulticentre, 13 medical and surgical ICUs at 5 hospitals, Analysis performed May to November 2023
- Multicentre
- 13 medical and surgical ICUs at 5 hospitals
- Analysis performed May to November 2023
Main finding
As reported in the abstract
SDM-aligned communication not associated with surrogate prognostic misunderstanding
−0.74
β; 95% CI −1.81 to 0.32P = .17
Observational data: associations, not effects.
Secondary outcomes
Physician prognostic misunderstanding · postmeeting
- SDM-aligned communication not associated with physician prognostic misunderstanding
- −0.51 (β; 95% CI −1.63 to 0.62; P = .38)
- Median (IQR) before: 12.0 [5.0 to 30.0] percentage points
- Median (IQR) after: 15.0 [5.0 to 29.0] percentage points; no significant change, P = .99
- Adjusted analyses
Surrogate postmeeting prognostic misunderstanding, surrogates with clinically significant premeeting misunderstanding (subgroup, n = 78 [56.9%])
- SDM-aligned communication associated with reduced misunderstanding
- −1.71 (β; 95% CI −3.09 to −0.34; P = .01)
- Prespecified subgroup analysis
Original publication
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