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, Jesse; Quinn, Thomas; Khan, Muhammad W.; Shutter, Lori; Goldberg, Robert J.; Col, Nananda; Mazor, Kathleen M.; and Muehlschlegel, Susanne, "Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians' Perceptions" (2018). UMass Center for Clinical and Translational Science Supported Publications. 154.
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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License