Evaluating Communication Practices in Life Sustaining Treatment Decisions for Patients with Out of Hospital Cardiac Arrest (OHCA)

Bhakti Patel – Assistant Professor of Medicine, Medicine, University of Chicago; Valerie Press, MD – Professor, Medicine, University of Chicago; William Parker, MD, PhD – Assistant Professor of Medicine, Medicine, University of Chicago

Abstract: Out-of-hospital cardiac arrest (OHCA) affects around 350,000 adults in the United States per year. Among survivors of OHCA, many have hypoxic ischemic brain injury (HIBI) resulting in decreased level of consciousness with uncertain or poor long-term neurologic recovery. Patients with HIBI are often comatose; thus, their surrogate decision makers (surrogates) are faced with decisions regarding continuation or withdrawal of life sustaining treatments (LSTs). Ethical decision making for incapacitated patients is based on a model of shared decision making between clinicians and surrogates. Prior research in mixed critical care populations has demonstrated multiple barriers to optimal shared decision making. Decision making for patients with OHCA is further complicated by uncertain neurologic prognoses. Currently, little is known about best practices for clinicians when discussing LST with surrogates of patients specifically with OHCA. The goal of this research is to characterize the current communication practices clinicians utilize in LST discussions with surrogates and evaluate how these practices impact long-term surrogate mental health outcomes. We will assess this via a mixed methods approach that includes qualitative analysis of recorded audio conversations between critical care clinicians and surrogates of patients with OHCA admitted to the ICU, in conjunction with a survey of surrogates assessing mental health outcomes at follow up out to 1 year. This study will lay groundwork for development of interventions aimed at improving ethical decision making around LST for patients with OHCA and long-term surrogate mental health outcomes. We will present preliminary findings of our analysis at the ASBH conference.

Keywords: Shared decision making, Surrogate decision makers, Out of hospital cardiac arrest (OHCA)