Investigators suggest that a checklist completed by physicians and family members of individuals with severe acute brain injury may improve management needs.
Improved communication between family members of individuals with severe acute brain injury (SABI) and physicians about palliative care needs can help them address and improve mental health outcomes, according to the results of a study published in JAMA Network Open.
Investigators suggested that a checklist completed by family members and physicians may help improve communication and targeted, timely management needs.
The prospective cohort study included individuals with SABI in an intensive care unit (ICU) for 2 days or longer and a score 12 or lower on the Glasgow Coma Scale. It also included their family members.
Between January 2018 and July 2021, investigators conducted the study at an academic hospital in Seattle, Washington. The data were analyzed between July 2021 and July 2022.
When individuals were enrolled in the study, family members and physicians completed a 4-item palliative care needs checklist.
A single member of each patient’s family enrolled completed questionnaires that assessed the perception of goal concordant care, satisfaction in the ICU, and symptoms of anxiety and depression.
Six months later, the family members assessed their decisional regret, patient functional outcome, patient quality of life, and psychological symptoms .
A total of 209 family member-patient pairs were included in the study. Individuals had experienced hypoxic-ischemic encephalopathy, stoke, and/or traumatic brain injury. At least 1 of these was identified for 185 patients or their families and 110 by physicians.
Investigators found that approximately 50% of family members enrolled with at least moderate anxiety or depression, with just 20% at the follow-up.
The mean for high level of depressive symptoms was 50%, and the mean for generalized anxiety disorder (GAD) was 46% with at least moderate anxiety.
In the follow-up, 19% had a high level of depressive symptoms and GAD was 22%.
Investigators adjusted for age, diagnosis, disease severity, and the family’s ethnicity and race. After the adjustment, physicians identified any need that was association with greater goal discordance and family decisional regret.
Family members identified any needs that were associated with greater symptoms of depression at follow-up and worse perceived patient quality of life.
The follow-up survey was returned by 155 of the family members with a mean of 4.8 months of follow-up after enrollment. The functional outcome was unknown for 5% of individuals. Approximately 46.5% had died.
In the adjusted models, there was no association between the main outcomes of anxiety and depressive symptoms and at least 1 need identified by a physician.
Compared with no identification of need, at least 1 need identification by physicians were associated with a 74% of a higher proportion of perceived goal-discordant care at enrollment and 17 points greater decisional regret at follow-up among families that were comparable by age, diagnosis, ethnicity, race, and severity.
Overall, investigators found that early communication between family members and physicians could be improved early in the ICU stay.
Plinke WV, Buchbinder SA, Brumback LC, Longstreth WT Jr, et al. Identification of palliative care needs and mental health outcomes among family members of patients with severe acute brain injury. JAMA Netw Open. 2023;6(4):e239949. doi:10.1001/jamanetworkopen.2023.9949