2026 American Academy of Neurology Abstract Website

Objective:

To explore the use of open-ended questions posed by the clinician early in the family meetings.

Background:

Clinician listening conveys respect & may be fostered by open-ended questions, which humanizes ICU communication & supports value-congruent care. This study examined the prevalence and types of early open-ended questions (EOEQs) and their association with surrogate ratings of clinician communication quality.

Design/Methods:

We conducted a cross-sectional analysis within the ongoing multi-center INSPIRE-CINP study (Identifying Strategies to Prognosticate and Inform Relatives in Critically Ill Neurologic/Neurosurgical Patients). A total of 87 audio-recorded clinician–family meetings with post-meeting questionnaires were analyzed from three U.S. neuroICUs, involving 79 patients, 133 family members, & 32 clinicians. EOEQs posed within the first third of the transcript were qualitatively coded by three independent raters, achieving high inter-rater reliability (κ >0.9). To account for variability in meeting length & frequency, we calculated standardized proportions of EOEQ subtypes. Associations between EOEQs & communication outcomes were examined using both overall perceived quality of communication ratings (assessed with a single global question) & validated instruments (Quality of Communication [QOC] & modified Patient-Perceived Patient-Centeredness [PPPC]). Analyses employed mixed-effects models adjusted for clustering by clinician, patient, & surrogate, with covariates retained if p >0.15 in univariate testing.

Results:

Across 87 meetings, 209 EOEQs were identified (median 2 per meeting, IQR 1–3): 66% addressed family understanding, 13% the patient as a person, 13% patient wishes, & 8% family needs. In multivariable models adjusted for day of meeting after admission, patient & surrogate age, surrogate health literacy, & clustering, a higher number of EOEQs was associated with lower overall perceived communication quality (–0.4, 95% CI –0.7 to –0.15; p=0.003). No associations were observed with QOC or PPPC.

Conclusions:

Examining EOEQs examines communication in neuroICUs. Paradoxically, more EOEQs were linked to lower surrogate ratings of overall communication quality, with no associations for QOC or PPPC. This may reflect surrogate preference for information early in meetings.