Inside Prognostication Meetings in the Neuro-Intensive Care Unit: How Clinicians Convey Evidence to Families – A Mixed-Methods Study

Objectives Effective communication with surrogate decision-makers is critical in neuro-intensive care settings, where complex prognostication shapes high-stakes decision-making. To better understand how clinicians convey prognostic evidence in clinician-family meetings for patients with severe acute brain injuries (SABI), we characterized and quantified types of evidence-sharing used by clinicians in these meetings and explored their independent predictors and associations with quality of communication (QOC) and patient-centeredness. Methods In this mixed-methods study, we first qualitatively analyzed 70 transcripts of audio-recorded routine clinician-family meetings for patients with SABI. Since it provides a clear and systematic taxonomy for classifying information, we applied an established legal framework to categorize clinician statements into four evidence types: “ Real” (current clinical status of the patient); “ Documentary” (research/literature regarding the patient's condition); “ Demonstrative” (diagnostic tests/imaging to explain the clinical status); and “ Testimonial” (disclosure of clinician's own personal experiences). Next, we employed univariate and multivariable mixed-models to explore predictors of evidence-sharing types, as well as associations with validated measures of surrogate-perceived QOC and patient-centeredness of care. Results We identified a total of 780 statements of evidence-sharing, of which the majority were “Real”(mean proportion 56 ± 23% across all transcripts), followed by “Demonstrative”(29 ± 22%), “Documentary”(12 ± 15%), and “Testimonial”(3 ± 6%), with substantial inter-meeting variability, as indicated by wide standard deviations. In univariate analyses, longer meetings and non-Latino/Hispanic patient ethnicity predicted more evidence-sharing statements; however, after multivariable adjustment accounting for clinician- and patient-level clustering, only meeting length remained significant. Exploratory analyses found no associations between the standardized proportion of any evidence type and surrogate-perceived QOC or patient-centeredness. Conclusions Clinicians’ disclosure of prognostic information to families of patients with SABI varied widely in quantity and type of evidence shared. Evidence type was not associated with surrogate-perceived QOC or patient-centeredness, suggesting that factors beyond evidentiary content may shape families’ communication experiences. Applying a structured framework to categorize evidence-sharing provides a novel way to systematically study prognostic communication in neurocritical care.