The objective of our study was to analyze the composition of clinician-surrogate dialogue in family meetings to understand how communication patterns influence decision-making in neurocritical care.

In the neurocritical care unit (NCCU), critically ill patients cannot speak for themselves, making family meetings essential for guiding care. We examined differences in clinician–family communication priorities & whether clinician statements about patient identity/values/preferences (PIVP) were associated with family ratings of patient-centeredness (PPPC).

We conducted a cross-sectional mixed-methods analysis of 78 de-identified transcripts of audio-recorded clinician–family meetings from the ongoing multi-center INSPIRE-CINP study (Identifying Strategies to Prognosticate and Inform Relatives in Critically Ill Neurologic/Neurosurgical Patients). A “statement” was defined as an uninterrupted sentence expressing a complete thought, categorized by clinician or family member. Statements were coded into one of 7 categories: neurodiagnostics/medical course, treatment options, patient identity/values/preferences, prognostication, trust building, support from others, or other. For each meeting, we quantified total & subtype frequencies, then calculated standardized proportions to account for differences in meeting length. Clinician–family differences in standardized proportions were compared with paired t-tests (Bonferroni-adjusted p<0.05). Univariate & multivariable mixed-effects models to adjust for clustering by clinician & patient were applied. We hypothesized that clinician statements about patient identity, values & preferences are associated with improved patient-centeredness of care.

Across 87 transcripts with 32 clinicians and 133 family members, we identified 40,909 statements, of which 26,619 (65%) were made by clinicians & 14,311 (35%) by families. With the exception of “treatment options” & “support by others,” all subtypes differed significantly between clinicians and families (Table). Contrary to our hypothesis, univariate & mixed-effects models showed no statistically significant association between the proportion of clinician PVP statements & higher PPPC scores.

Clinicians & families demonstrate distinct communication priorities, yet greater clinician focus on patient values was not associated with higher family ratings of patient-centered care, potentially reflecting residual confounding or measurement limitations.