Objective:

To characterize and quantify the types of evidence-sharing utilized by clinicians when speaking with family members of Critically-Ill Neurologic Patients (CINP).

Background:

When disclosing a CINP’s prognostication to their families, clinicians employ various methods of evidence-sharing. Little is known about the types of information clinicians choose to disclose but has the potential to improve clinician-family communication and family members’ understanding of the CINP’s prognosis, which is crucial for shared decision-making.

Design/Methods:

We qualitatively analyzed 48 de-identified transcripts of audio-recorded routine clinician-family meetings concerning CINPs at a U.S. academic medical center during which prognostication was provided. We applied an existing legal framework of evidence-sharing to deductively classify different types of information-sharing. In accordance with this framework, clinician statements were classified into “Real” (conveying the current status of the CINP), “Documentary” (reference to current research and literature regarding the CINP’s care), “Demonstrative” (utilization of diagnostic modalities), and “Testimonial” (disclosure of personal experiences of the clinician) evidence. We used descriptive statistics to compare the types of evidence-sharing used to total numbers of evidence-sharing statements made. 

Results:

We identified a total of 621 statements of evidence-sharing. Across 48 transcripts, the average ratio of a specific type of evidence-sharing served as a summary measure for understanding primary communication approaches. The majority of statements were “Real” evidence statements (54%±15%) meaning, on average, clinicians dedicated more than half of their evidence-sharing statements disclosing the physical status of the CINP. “Demonstrative” (28%±18%), “Testimonial” (14%±15%) and “Documentary” (4%±6%) types of evidence sharing were less common amongst clinicians. 

Conclusions:

Clinicians disclose information to surrogate decision makers with high variability and rarely disclose personal experiences concerning their own critically-ill family members or experiences of other families of CINP. As one way to improve shared decision-making, future research should explore associations between evidence-sharing methods and prognostic concordance between clinician and surrogate-perceived prognosis of CINP.