Predictors of family satisfaction with support during shared decision making in neuroscience intensive care units (S23.005)

Objective: The study objective was to identify patient- and family-related factors associated with complete satisfaction with shared decision making support among families of neurocritically ill patients. Background: Only about 50% of families of neuroscience intensive care unit (NICU) patients report being completely satisfied with the support provided during shared decision making. Identifying factors associated with satisfaction may inform strategies to improve how clinicians approach families in making shared decisions. Design/Methods: We conducted a retrospective observational cohort study using a database of Family Satisfaction in the ICU 24 (FS-ICU 24) surveys collected from the NICUs at two US academic medical centers. The FS-ICU 24 is a validated instrument that asks a patient’s family member at time of ICU discharge to rate satisfaction with aspects of ICU care on Likert scales, with one item asking about satisfaction with decision making support. We dichotomized top-box responses to this item and identified patient- and family-related factors associated with complete satisfaction using multivariate regression. Results: We included 364 available surveys, each completed by one family member of 364 separate NICU admissions. 175 (48.1%) of the surveys indicated complete satisfaction with support during decision making. Only 3 of the 25 patient and family covariates in our multivariate model predicted complete satisfaction: the patient being female (OR=1.66, 95% CI 1.07–2.59, p=0.02); the family reporting three or more family meetings during admission (OR=2.64, 95% CI 1.50–4.79, p=0.0008), and the patient having code status changed to DNR during admission (OR=7.89; 95% CI 2.33–33.49, p=0.002). Conclusions: While we confirmed that only 48.1% of NICU families were completely satisfied with support provided for shared decision making, we were only able to identify 3 patient- and family-related predictors of complete satisfaction. Future studies to improve family satisfaction with NICU decision making support should have broad inclusion criteria. Disclosure: Dr. Ou has nothing to disclose. Dr. Garritano has nothing to disclose. Dr. Weber has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Knies has nothing to disclose. Dr. Nhundu has nothing to disclose. Dr. Bautista 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. Rosand has received personal compensation for activities with Pfizer as a member of the Data Safety Monitoring Board. Dr. Hwang has received research support from American Brain Foundation Practice Research Training Fellowship, Apple Pickers Foundation, Neurocritical Care Society, National Institute of Health.