Documented Family-Clinician Interactions Prior to Palliative Care Consultation Associated With Less Withdrawal of Life-Sustaining Therapy Among Patients With Traumatic Brain Injury

Abstract

Background

Traumatic brain injury (TBI) often requires decisions about withdrawal of life-sustaining therapy (WLST). Palliative care consultation (PCC) plays a central role in facilitating these decisions, yet the impact of family-clinician communication on WLST remains underexplored. We aimed to examine predictors of WLST, particularly focusing on documented family-clinician interactions prior to PCC.

Methods

We conducted a retrospective cohort study of patients with TBI admitted to a unified health system between 2016 and 2022 who received both neurosurgical consultation and PCC. The key exposure included the number of documented family-clinician interactions prior to PCC. Multivariable logistic regression and LASSO regression were used to assess associations with WLST while adjusting for potential clinical confounders including injury severity and treatment intensity.

Results

Among 228 patients with TBI (median age 81 years, 53% male), 51% (N = 117) experienced WLST. A greater number of documented family-clinician interactions prior to PCC was associated with lower odds of WLST (adjusted OR, 0.95; P = .02). LASSO regression confirmed documented number of family-clinician interactions, as well as radiographic midline shift, as independent predictors.

Conclusions

Family engagement may be associated with WLST decisions in patients with TBI eventually receiving PCC, as increasing documented family-clinician communication prior to PCC was associated with reduced likelihood of WLST. Although this study does not establish causation, it raises the hypothesis that more frequent family communication may influence goals-of-care decision-making independently of clinical severity and merits prospective evaluation.