Full study name: Identifying Strategies to Prognosticate and Inform Relatives in Critically Ill Neurologic Patients (INSPIRE-CINP)

Funding: The Neurology Department Harkin Family Fund

Study Overview

This study is an empirical, ongoing, multicenter observational study of clinician-family communication and prognostication for neurologic and neurosurgical patients who are critically ill. After verbal consent for this minimal risk study, the research team audio-record routine clinician-family meetings, during which prognostication, treatment options and sometimes goals-of-care are discussed. After the meetings, we collect quantitative data using validated questionnaires with minimal participant burden. The audio recordings are transcribed and de-identified using Health Insurance Portability and Accountability Act-certified and Institutional Review Board-approved methods. We apply validated qualitative and quantitative (mixed methods) analyses to understand the connection among communication, decision-making and patient and family outcomes. This research enables target discovery for communication and education interventions to improve clinicians’ prognostic disclosure.

Publications:

• Ge C, Goss AL, Crawford S, Goostrey K, Sun PB, Shields AM, Hough CT, Lo B, Carson S, Steingrub J, White DB, Muehlschlegel S. “Variability of Prognostic Communication in Critically Ill Neurologic Patients: A Pilot Multicenter Mixed-Methods Study.” Crit Care Explor. 2022, 4(2).
• Goss AL, Ge C, Crawford S, Goostrey K, Buddadhumaruk P, Hough CL, Carson S, Steingrub J, White DB, Muehlschlegel S. Prognostic Language in Critical Neurologic Illness: A Multicenter Mixed-Methods Study. Neurology. 2023 Aug. 1;101(5):e558–e569.
• Fleming V, Prasad A, Ge C, Crawford S, Meraj S, Hough CL, Lo B, Carson SS, Steingrub J, White DB, Muehlschlegel S. “Prevalence and Predictors of Shared Decision-making in Goals-of-Care Clinician-Family Meetings for Critically Ill Neurologic Patients: A Multicenter Mixed-Methods Study.” Crit Care. 2023 Oct. 21;27(1):403.

Abstracts:

• Prasad, A; Ge, C; Goostrey, K; Armanios, B; Shields, AM; Sun, PB; Hough, CT; Steingrub, J; White, DB; Muehlschlegel S. Shared Decision-Making in Goals of Care Meetings for Critically Ill Neurologic Patients: A Multi-enter Mixed-methods Study. Poster presentation at the Neurocritical Care Society annual meeting, Chicago (2021).
• Ge, C; Goss, A; Crawford, S; Goostrey, K; Sun, PB; Hough, CT; Lo, B; Carson, S; Steingrub, J; White, DB, Muehlschlegel S. Clinicians’ Approaches to Goals-of-Care Communication for Critically Ill Neurologic Patients: A Pilot Multicenter Qualitative Study. Poster presentation at the Neurocritical Care Society annual meeting, Chicago (2021).
• Goss, A; Ge, C; Crawford, S; Goostrey, K; Shields, AM; Sun, PB; White, DB, Muehlschlegel S. “We Don’t Have a Crystal Ball”: A Multicenter Study of the Words Clinicians Use to Disclose Prognosis to Families of Patients with Critical Neurologic Illness. Poster presentation at the Neurocritical Care Society annual meeting, Chicago (2021).
• Fleming, V; Prasad, A; Crawford, S; Ge, C; Goostrey, K; Sun, PB; Hough, CT; Steingrub, J; White, DB; Muehlschlegel S. Predictors of Shared Decision-Making in Goals-of-Care Clinician-Family Meetings for Critically Ill Neurologic Patients: A Multicenter Mixed-Methods Study. 20th Neurocritical Care Society annual meeting, San Antonio (2022) (Distinguished poster abstract presentation).
• Kotamreddy M, Honzel B, Carandang C, Muehlschlegel S. Evidence-Sharing Methods Utilized by Clinicians During Prognostication Meetings for Critically Ill Neurologic Patients. 22nd Neurocritical Care Society annual meeting, San Diego (2024) (Distinguished abstract).
• Honzel B, Kotamreddy M, Carandang C, Muehlschlegel S. Exploring Jargon Use Among Clinicians During Prognostication Meetings with Surrogate Decision-Makers for Critically Ill Neurologic Patients. 46th Society for Medical Decision Making annual meeting, Boston (2024) (2024 Margaret Holmes-Rovner Award for Outstanding Presentation in Decision Psychology and Shared Decision Making).