Brain Computer Interface Technology Impacts Physician Perspectives on Prognostication and ICU Decision Making in Patients With Stroke and Traumatic Brain Injury
Karen Hirsch1, Krysta Barton1, Elizabeth Osborn1, Sydney Walls1, Arely Campos-Melendez1, Holly Tabor1
1Stanford University
Objective:
To evaluate the impact of brain computer interface (BCI) technology as a speech and motor prosthesis on physician perspectives about acute decision making for patients with stroke and traumatic brain injury (TBI).
Background:
Disability after stroke and TBI is pervasive; over 600,000 patients become newly disabled every year from these conditions. The availability of BCI to mitigate the impact of disabilities may affect how stakeholders consider prognosis and long-term outcomes, and in turn may impact decision-making in the neurocritical care setting. Thus there is an un-met need to evaluate the implications of BCI technology for the physicians caring for these patients.
Design/Methods:
We conducted semi-structured interviews with 50 physicians to explore experiences related to BCI. Interviews were audio-recorded, transcribed verbatim, and de-identified. A codebook was created using an inductive iterative approach. Two researchers coded all transcripts using Dedoose software, with a third coder involved in weekly meetings to reach consensus. Coded data were summarized to highlight key points and illustrative quotes, facilitating comparison across participants. Final analysis resulted in theme development around prognostic impact and physician concerns.
Results:
Physician specialties included critical care (29, 58%), neurology (15, 30%), and other (6, 12%). Most practiced in academic settings (40, 80%). Physicians had contrasting views on how BCI would impact acute prognostication. Two prognostic themes emerged: 1) that BCI would change prognostication on patients that typically would have been predicted to have minimal improvements in motor or speech function after injury; or 2) no change in prognostication in the acute phase given significant uncertainties and limitations in prognosticating in this setting. Additional themes identified physician concerns about how BCI would influence surrogate opinions about disability and decision-making about supportive interventions like tracheostomy and gastrostomy.
Conclusions:
Physicians had varying views on how BCI would impact acute decision-making for patients with acquired brain injury from stroke and TBI.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.