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Should We Use the IMPACT-Model for the Outcome Prognostication of TBI Patients? A Qualitative Study Assessing Physicians’ Perceptions

Authors :
Jesse Moskowitz BS
Thomas Quinn BS
Muhammad W. Khan MBBS
Lori Shutter MD
Robert Goldberg PhD
Nananda Col MD, MPP, MPH
Kathleen M. Mazor EdD
Susanne Muehlschlegel MD, MPH
Source :
MDM Policy & Practice, Vol 3 (2018)
Publication Year :
2018
Publisher :
SAGE Publishing, 2018.

Abstract

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.

Subjects

Subjects :
Medicine (General)
R5-920

Details

Language :
English
ISSN :
23814683
Volume :
3
Database :
Directory of Open Access Journals
Journal :
MDM Policy & Practice
Publication Type :
Academic Journal
Accession number :
edsdoj.67c035fc1d23406daf109a4addb561ff
Document Type :
article
Full Text :
https://doi.org/10.1177/2381468318757987