Data associated with the 2020 JAMA Network Open publication entitled: ‘Effect of intensivist communication in a simulated setting on interpretation of prognosis among family members of patients at high risk of intensive care unit admission: A randomized trial'

Importance: Intensivist-surrogate discordance about prognosis is common in the intensive care unit (ICU). Empowering families to make informed decisions about their loved one’s care is important, but it is unclear how best to communicate prognostic information to vulnerable surrogates when a patient is expected to die. Objective: To test the hypothesis that family members interpret intensivists as being more optimistic when their questions about prognosis are answered indirectly. Design: Between September 27 and October 17, 2019 we conducted a web-based randomized trial of video vignettes depicting an intensivist answering a standardized question about the prognosis of a patient at high risk for death on ICU day 3. Setting: Web-based simulation Participants: National sample of adult children, spouses/partners, or siblings of patients with COPD on long term oxygen therapy. Participants were excluded if they had worked as a doctor, nurse, or advanced practice provider. Intervention: Participants were randomized to view one of 4 intensivist communication styles in response to the question “What do you think is most likely to happen?”: 1) a direct response (control), 2) an indirect response comparing the patient’s condition to other patients, 3) an indirect response describing physiology, or 4) redirection to a discussion of patient values and goals. Main Outcomes and Measures: Participant responses to two questions: 1) “If you had to guess, what do you think the doctor thinks is the chance that your loved one will survive this hospitalization?” and 2) “What do you think are the chances that your loved one will survive this hospitalization?” answered using a 0%-100% probability scale. Results: 302 participants completed the trial, of whom 204 (68%) were female and 165 (55%) were adult children of the patient. Compared to a direct response, participants perceived the intensivist to have a significantly more optimistic prognostic estimate when viewing an indirect response referencing other patients (β=10 [95% confidence interval (CI) 1, 19]; p = 0.03), physiology (β=10 [95% CI 0, 19]; p = 0.04), or redirection to a discussion of patient values and goals (β=19 [95% CI 10, 28]; p Conclusions and Relevance: Family members interpret indirect responses to questions about prognosis in the ICU setting as more optimistic than direct responses