SHM Converge Scientific Abstract ePoster Gallery-Shared Decision-Making and Surrogate Prognostic Misunderstanding After Family Meetings

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This study examined whether shared decision-making (SDM) during family meetings in intensive care units helps surrogates better understand a patient’s prognosis.<br /><br />Researchers conducted a retrospective cohort study using data from 137 family meetings across 13 ICUs in 5 hospitals. Before and after each meeting, they measured surrogate prognostic misunderstanding as the absolute difference between the clinician’s prognosis estimate and the surrogate’s perception of that estimate. They also calculated a summative SDM score for each meeting.<br /><br />Overall, surrogate prognostic misunderstanding improved after family meetings, with the median dropping from 22.0% before the meeting to 15.0% after the meeting. However, SDM was not associated with reduced misunderstanding in the full sample, either in unadjusted or adjusted analyses.<br /><br />A key finding emerged in a pre-specified subgroup: among surrogates who had clinically significant misunderstanding at baseline (defined as 20% or greater), higher SDM was significantly associated with reduced misunderstanding after the meeting. This suggests SDM may be especially helpful for surrogates who start out with major gaps in understanding.<br /><br />The authors conclude that SDM does not consistently improve surrogate understanding of prognosis across all family meetings, but it may reduce misunderstanding in surrogates with the greatest baseline confusion. They recommend further research to identify strategies that better correct prognostic misunderstanding in serious illness communication.

Asset Subtitle

Judith Vick

Meta Tag

Author List Ben Berger, Christopher Cox, Deepshikha Ashana, HyunBin You, Jessica Ma, Judith Vick, Marie Haverfield

Category Research

Concept Shared Decision-Making

Concept Prognostic Misunderstanding

Concept Surrogate Decision Maker

Concept Family Meeting

Concept Prognosis

Distinguished Finalist

Presenter Organization Department of Medicine, Duke University, Durham NC

Presenter Organization Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health System, Durham NC

Presenter Organization National Clinician Scholars Program

Presenting Author Judith Vick

Track Communication

Keywords

shared decision-making

family meetings

intensive care units

surrogate prognostic misunderstanding

prognosis perception

retrospective cohort study

serious illness communication

clinician estimate

baseline misunderstanding

family conference

Shared Decision-Making

Prognostic Misunderstanding

Surrogate Decision Maker

Family Meeting

Prognosis