D93-08 Communication of Functional Status and Functional Prognosis in Critical Illness

Abstract Rationale In critical illness, functional recovery is an important patient-centered outcome. Discussions of functional prognosis with patients and families can be an important part of informing value-aligned decisions regarding life-sustaining treatments. However, little is known about how function and functional prognosis are communicated among ICU clinicians, patients, and surrogates. Methods We conducted a qualitative descriptive secondary analysis of ICU family meeting transcripts collected from 5 hospitals as part of a multi-center clinical trial of a decision aid among adult patients receiving prolonged mechanical ventilation. We performed content analysis with both inductive and deductive approaches to develop a framework that describes the aspects of function and functional prognosis communicated during the meetings. We used a maximum variation sampling approach across a range of physician-estimated one-year survival prognosis to capture the full spectrum of discussions among patients with different illness severities. We analyzed family meetings until achieving thematic saturation. Results Across 25 family meetings, we identified 144 instances (mean 6, interquartile range 4-9 per meeting) in which function or functional prognosis were discussed. We categorized the instances by types of function and temporal contexts (Figure 1). Types of function include basic, activities of daily living/instrumental activities of daily living (ADL/IADL), higher level, or proxies of function (discharge disposition, quality of life). Temporal contexts include past, current, or future function. We subcategorized discussions of future function (i.e. functional prognosis) into endpoints and processes. Endpoints refer to long-term outcomes that are likely permanent or reaching the plateau of recovery, whereas processes refer to the course of recovery before an endpoint is reached (including expected duration, milestones and setbacks). There were fewer discussions of functional prognosis in terms of endpoints than processes (41 vs. 59 instances), and more expression of higher uncertainty when discussing endpoints than processes (17 out of 41 instances (42%) vs. 12 out of 59 instances (20%)). Conclusions We report the first comprehensive framework that describes discussions of function and functional prognosis in critical illness. Communication of functional prognosis takes into account both the processes of recovery and the eventual endpoints of functional outcome. It is possible that clinicians preferentially discuss more processes or avoid discussing endpoints due to higher uncertainty associated with endpoints. Our study provides a framework for future studies of improving communication of function and functional prognosis in critical illness. This abstract is funded by: N/A