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Our new #OpenAccess work @AnnalsATS examines how ICU doctors talk to families when they don’t expect a patient to survive. Congratulations to @SVasherMD, Sandra Zaeh of the @JHUPCCMFellows, and @mneakin
#ICU #PalliativeCare @creativecommons

atsjournals.org/doi/abs/10.151…
63 intensivists in the intervention arm of the SCIP trial (NCT02721810) answered the question “Do you expect this patient to survive to hospital discharge?”

50 of the 63 in the intervention arm answered that they did NOT expect the patient to survive.
These intensivists then participated in a recorded simulated family meeting.

During the meeting, 25 intensivists told the actor playing the daughter that her dad might not live. The actor responded verbatim:

“What do you think is most likely to happen?”
Responses to the surrogate’s question regarding prognosis ranged from 18 to 995 words, with a mean of 204.

We identified 4 types of answers: direct, indirect, non-answer, and redirection.

Remember, all these intensivists agreed that the patient wasn’t likely to survive.
The majority of intensivists combined different types of answers as they spoke.

14 (56%) answered the question directly at some point within their response.
What's new?
Well, a 2007 analysis of actual ICU family meetings (ncbi.nlm.nih.gov/pubmed/17205000) found that prognosis was NOT discussed 1/3 of the time. But, we didn’t know if those families WANTED prognostic information. In our study, the surrogate explicitly asked to know prognosis.
Take homes for ICU families:
1) Not all doctors will answer your question about prognosis directly.
2) If it seems like different doctors are telling you different things, that doesn’t necessarily mean they disagree with each other.

They may just communicate very differently.
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