Navigating Uncertain Outcomes: A Case Study on Preference-Sensitive Decision-Making in Neurocritical Care

Abstract

Background

Navigating health-related decisions after severe acute brain injury (SABI) can be challenging, especially when the patient’s preferences and the prognosis remain unclear. This uncertainty adds a layer of complexity for surrogates and medical teams striving to make treatment choices.

Purpose

To address these challenges, this article presents an interview study examining decisions that were retrospectively relevant for a surrogate decision-maker.

Study Design

Key moments for shared decision-making and advance care planning were identified and compared to a theoretical decision model, providing valuable insights for decision-making in the context of SABI given time-pressure, prognostic uncertainties, and the patient’s neurological impairment.

Study Sample

A semi-structured interview was conducted with the 31-year-old daughter of a 53-year-old woman who had experienced an aneurysmal subarachnoid hemorrhage.

Analysis and Results

The interview was thematically analyzed, and eight preference-sensitive decision moments were identified and visualized within a timeline: bleeding event, emergency treatment, intensive care unit treatment (general), severe complication, long-term life-sustaining surgical interventions, admission to rehabilitation, further severe complication, and palliation.

Conclusion

In conclusion, this case study supports an iterative evaluation of treatment preferences and suggests well-suited moments for reevaluation of medical treatment goals and shared decision-making within a timeline. This framework may serve to facilitate shared decision-making by identifying key preference-sensitive junctures and providing a basis for designing tools that incorporate deliberate timing.