Profiles of Neurological Outcome Prediction Among Intensivists
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Advances in intensive care medicine have increased survival rates of patients with critical neurological conditions. The focus of prognostication for such patients is therefore shifting from predicting chances of survival to meaningful neurological recovery. This study assessed the variability in long-term outcome predictions among physicians and aimed to identify factors that may account for this variability.
Based on a clinical vignette describing a comatose patient suffering from post-anoxic brain injury intensivists were asked in a semi-structured interview about the patient’s specific neurological prognosis and about prognostication in general. Qualitative research methods were used to identify areas of variability in prognostication and to classify physicians according to specific prognostication profiles. Quantitative statistics were used to assess for associations between prognostication profiles and physicians’ demographic and practice characteristics.
Eighteen intensivists participated. Functional outcome predictions varied along an evaluative dimension (fair/good–poor) and a confidence dimension (certain–uncertain). More experienced physicians tended to be more pessimistic about the patient’s functional outcome and more certain of their prognosis. Attitudes toward quality of life varied along an evaluative dimension (good–poor) and a “style” dimension (objective–subjective). Older and more experienced physicians were more likely to express objective judgments of quality of life and to predict a worse quality of life for the patient than their younger and less experienced counterparts.
Various prognostication profiles exist among intensivists. These may be dictated by factors such as physicians’ age and clinical experience. Awareness of these associations may be a first step to more uniform prognostication.
KeywordsPrognosis Coma Critical care Ethics Neurology Neuroethics
The authors would like to acknowledge the contribution of all volunteer participants for their time and openness as well as Tessa Watt for research assistance. Support for this research comes from the Social Sciences and Humanities Research Council of Canada (E.R.) the Institut de recherches cliniques de Montréal (E.R.), the Fonds de la recherche en santé du Québec (E.R.), the Canadian Institutes of Health Research (E.R.), and the National Institutes of Health/National Institute of Neurological Disorders and Stroke, (R01 #NS045831, J.I. and K23 NS051372, M.L.).
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