Principal Invistigator: Christos Lazaridis, Associate Professor of Neurology

A common cause of death after severe brain injury is withdrawal of life-sustaining measures. These withdrawals follow communications among health care personnel and family members or surrogate decision makers. Nevertheless, insufficient attention has been paid to the conceptual and practical challenges involved in carrying out such discussions. Recent research agenda for communication with seriously ill patients calls for further investigation on “the impact of specific clinician words and expressions”. A small amount of nonempirical literature identifies problematic words and phrases used in neurocritical care (e.g., “devastating”, “life not worth-living”, “vegetative”, “minimally conscious”). These are described as “confusing” or conveying “unintended negative messages”. However, there is still a dearth of empirical literature examining the impact of specific clinician words and expressions. In our clinical experience caring for critically ill patients and their family members at several institutions, physicians use certain words and expressions with potentially widely different meanings than perceived from family members and surrogate decision makers. Based on this experience, we hypothesize that physicians understand words and expressions such as “coma”, “vegetative”, “poor outcome or poor survival”, “neurologically devastated or impaired”, differently than surrogates do. These differences in understanding may contribute to miscommunication about prognosis, quality of life, and treatment options. Additionally, disputes about potentially inappropriate or futile treatments, which are common after brain injury, hinge on whether a patient’s outcome would be consistent with that person’s values. Therefore, a deeper understanding of these expressions may improve communication among physicians, and surrogates, thereby improving the quality of decision-making and reducing conflicts and unintended outcomes.

Lazaridis aims to design a qualitative study to explore how non-physicians and physicians interpret the above referenced words and expressions. In accordance with a symbolic interactionist model for qualitative communication research, Lazaridis assumes that individuals interpret words based on social context. Lazaridis will focus on the context of physician conversations with surrogates of critically ill brain-injured patients. Exploring communication is the first step in potentially devising communication tools and decision-aids that will improve surrogate-clinician interactions and optimize shared decision-making for incapacitated brain injured patients.