Decision proposals in the family conference

Abstract

Objectives: To explore how clinicians make decision proposals about life-sustaining treatments and to determine if certain decision proposals are more likely to lead surrogates to align with or resist the proposal.

Methods: We audio-recorded 36 family conferences between clinicians and surrogates and analyzed the interactions using conversation analysis (a qualitative method) and event sequence analysis (a quantitative method).

Results: The transitional probability of a proposal that incorporates the patient's previously described preferences leading to alignment with the proposal was .76. The odds ratio of an aligning response in the presence of this proposal was 8.27 (95% CI 2.21, 30.97). The transitional probability of a proposal that asserts the healthcare team is going to do or not do a treatment leading to resistance was .70. The odds ratio of a resisting response in the presence of this proposal was 8.4 (95% CI 1.83, 38.53).

Conclusions: There is evidence to suggest that incorporating the patient's previously described preferences into a decision proposal leads to surrogates' alignment to those proposals.

Practice implications: These results strengthen the need for clinicians to engage with surrogates in shared decision making to determine the best treatment decision for the patient.

Keywords: Communication; Decision making; Intensive care unit; Life support care; Patient preference; Professional-family relations.