How to achieve goal-concordant care in severe acute brain injury?

Discussing prognostic estimates and goals of care may improve the alignment of medical decisions with the patient’s wishes, a Swiss study among patients with severe acute brain injury (SABI) indicated.

“Patients with SABI lack decisional capacity,” said Dr Nawfel Ben-Hamouda (Lausanne University Hospital, Switzerland). “So how can we go about the shared decision-making process?” Dr Ben-Hamouda explained that ‘goal-concordant care’ is to understand a patient’s individual goals and values and to align medical treatment decisions with these goals. The current study compared the alignment between the patient’s wishes and the level of care that was received, by analysing the patient’s medical documentation, the perspective of the patient’s surrogates/family members, and the perspective of the clinicians [1]. The included patients with SABI (n=110) were followed for 6 months.

Surrogates appeared to be more inclined than clinicians to think that the patient would want to receive life-prolonging care by certain measures, excluding resuscitation, whereas doctors and nurse clinicians were more inclined to think that the patient would want to receive life-prolonging care by all medically indicated measures, displaying a first discordance between perspectives. Furthermore, clinical caretakers were more frequently unsure about the goals of the patient than the family members. Finally, the study showed that 46% of the family members’ decisions were influenced by prognostic scores, suggesting that prognostic scores may be valuable tools to improve goal-concordant care.

1. Behaghel G, et al. Prognostic scoring and goal-concordant care after severe acute brain injury: a mixed-method study. 10th EAN Congress, 29 June–2 July 2024, Helsinki, Finland.

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Posted on 25 July 202425 July 2024