Department of Neurology; Department of Quantitative Health Sciences; Meyers Primary Care Institute; Department of Internal Medicine; School of Medicine
Critical Care | Health Policy | Health Services Administration | Health Services Research | Neurology | Translational Medical Research
Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians' perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians' preferences for communicating prognostic information towards families. Methods. We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurosurgery,neurocritical care,trauma,palliative care) at 7 U.S. academic medical centers. We used performed qualitative content analysis of transcribed interviews to identify major themes. Results. Only 12 physicians (60%) expressed awareness of the IMPACT-model; two stated that they "barely" knew the model. Seven physicians indicated using the model at least some of the time in clinical practice, although none used it exclusively to derive a patient's prognosis. Four major themes emerged: the IMPACT-model is intended for research but should not be applied to individual patients; mistrust in the IMPACT-model derivation data; the IMPACT-model is helpful in reducing prognostic variability among physicians; concern that statistical models may mislead families about a patient's prognosis. Discussion: Our study identified significant variability of the awareness, perception, and use of the IMPACT-model among physicians. While many physicians prefer to avoid conveying numeric prognostic estimates with families using the IMPACT-model, several physicians thought that they "ground" them and reduce prognostic variability among physicians. These findings may factor into the creation and implementation of future ciTBI-related DAs.
UMCCTS funding, IMPACT-model, critical care, goals-of-care decisions, outcomes, prognosis, qualitative research, shared decision making, traumatic brain injury
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DOI of Published Version
MDM Policy Pract. 2018 Mar 26;3(1):2381468318757987. doi: 10.1177/2381468318757987. eCollection 2018 Jan-Jun. Link to article on publisher's site
MDM policy and practice
Moskowitz J, Quinn T, Khan MW, Shutter L, Goldberg RJ, Col N, Mazor KM, Muehlschlegel S. (2018). Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians' Perceptions. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.1177/2381468318757987. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/154
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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License