Priorities of surrogate decision makers when making decisions for intracerebral hemorrhage patients with poor prognosis: a latent class analysis of the US population (P3.033)

Objective: Our aim was to determine whether members of the US population, when deciding whether a relative devastated by intracerebral hemorrhage (ICH) should receive a tracheostomy and permanent feeding tube versus comfort care only, could be segmented into distinct groups, based on their prioritization of decisional concerns. Background: Defining like-minded clusters of surrogate decision makers may identify novel approaches for tailored development of goals-of-care decision aids. Design/Methods: We developed and piloted an online survey that (1) presented a scenario of an elderly relative intubated following ICH with poor neurologic prognosis, needing tracheostomy and feeding tube insertion for survival; and (2) utilized best-worst scaling to obtain a rank ordering of decisional concerns from the respondent acting as the patient’s surrogate. Respondents were then recruited from a probability-based US population sample. Latent class analysis was performed on the subjects’ responses. Results: 796 subjects completed the survey. Latent class analysis demonstrated that respondents’ prioritization of concerns could be classified into 5 groups. Nearly all respondents listed (1) respecting the patient’s wishes and (2) ensuring a comfortable death as their top 2 concerns. However, respondents in the largest group (Group 1, n=216) were concerned with trusting the given prognosis and were most likely to feel guilty about limiting treatment. Group 2 (n=174) was so concerned with an elderly patient not suffering with life support that these concerns outweighed consideration of the patient’s own wishes. Group 3 (n=163) focused on family agreement regarding decisions, while Group 4 (n=150) reported that religious beliefs were top priority. Group 5 (n=93) was most inclined to consider financial factors. Conclusions: We identified 5 types of decisional patterns for surrogates of ICH patients with poor prognosis, based on their prioritization of concerns. These data will inform development of decision aids tailored to address clusters of surrogate decision makers with similar decisional priorities. Study Supported by: American Brain Foundation Practice Research Training Fellowship; Neurocritical Care Society Research Training Grant; Apple Pickers Foundation (Westerly, RI); National Institute on Aging Loan Repayment Program. Disclosure: Dr. Hwang has received research support from American Brain Foundation Practice Research Training Fellowship, Apple Pickers Foundation, Neurocritical Care Society, National Institute of Health. Dr. Knies has nothing to disclose. Dr. Holloway has received personal compensation for activities with Milliman Guideline, Inc. as a consultant. Dr. White has nothing to disclose. Dr. Sheth has received personal compensation in an editorial capacity Current Treatment Options in Neurology. Dr. Sheth has received research support from Remedy Pharmaceuticals, Inc. Dr. Fraenkel has nothing to disclose.