499: Differences in Communication Between Clinicians and Surrogates in Neurocritical Care Family Meetings

Introduction: Effective clinician-family communication is central to fostering trust, respect, & collaboration in neurocritical care, where patients are acutely ill & unable to speak for themselves. In place of direct clinician-patient communication, family meetings are a vital forum for clinicians & families to discuss patient preferences & inform key aspects of care. However, in this high- stakes, medically-complex environment, communication priorities vary widely. Our objective was to analyze the composition of clinician-surrogate dialogue in family meetings to understand how communication patterns influence decision-making & the overall care experience. Methods: This study analyzes de-identified transcripts of audio-recorded clinician-family meetings from a multi-center, observational study. In this analysis, we coded 10 transcripts with NVivo (Denver, Colorado) to examine communication structure & content. Five transcripts were double-coded by two coders, achieving a prevalence-adjusted inter-rater reliability (kappa) of 0.88. The remaining five transcripts were coded individually. We defined a statement as an uninterrupted sentence expressing a complete thought. Then, we classified clinician & family statements into five categories: neurodiagnostics, prognostication, patient values & preferences, shared decision- making, & other. Coding discrepancies were resolved through discussion. To analyze this data for statistically significant differences between clinician & family communication, we performed frequency & chi-square analyses. Results: Our results revealed that 30% of clinician & family statements were focused on neurodiagnostics, 24% on prognostication, 16% on patient preferences and values, 15% on shared decision-making, & 15% on other topics (including introductions and farewells). Additionally, clinicians contributed disproportionately more neurodiagnostic (34% vs 20%) & prognostic statements (28% vs 17%;both p< 0.01), while families contributed more statements regarding patient preferences & values (23% vs 12%; p< 0.01). Conclusions: These results suggest distinct differences in communication between clinicians & surrogates in neurocritical care. In the future, this work will inform strategies to enhance clinician-family communication & facilitate patient-centered shared decision-making.