Jaffa Matthew N, Kirsch Hannah L, Creutzfeldt Claire J, Guanci Mary, Hwang David Y, LeTavec Darlene, Mahanes Dea, Steinberg Alexis, Natarajan Girija, Zahuranec Darin B, Muehlschlegel Susanne
Hartford Hospital.
Stanford University School of Medicine.
Res Sq. 2023 Jun 26:rs.3.rs-3084539. doi: 10.21203/rs.3.rs-3084539/v1.
In order to facilitate comparative research, it is essential for the fields of neurocritical care and rehabilitation to establish common data elements (CDE) for disorders of consciousness (DoC). Our objective was to identify CDEs related to goals-of-care decisions and family/surrogate decision-making for patients with DoC.
To achieve this, we formed nine CDE working groups as part of the Neurocritical Care Society's Curing Coma Campaign. Our working group focused on goals-of-care decisions and family/surrogate decision-makers created five subgroups: (1) clinical variables of surrogates, (2) psychological distress of surrogates, (3) decision-making quality, (4) quality of communication, and (5) quality of end-of-life care. Each subgroup searched for existing relevant CDEs in the NIH/CDE catalog and conducted an extensive literature search for additional relevant study instruments to be recommended. We classified each CDE according to the standard definitions of "core," "basic," "exploratory," or "supplemental," as well as their utility for studying the acute or chronic phase of DoC, or both.
We identified 32 relevant pre-existing NIH CDEs across all subgroups. A total of 34 new instruments were added across all subgroups. Only one CDE was recommended as disease core, the "mode of death" of the patient from the clinical variables subgroup.
Our findings provide valuable CDEs specific to goals-of-care decisions and family/surrogate decision-making for patients with DoC that can be used to standardize studies to generate high-quality and reproducible research in this area.
为了促进比较研究,神经重症监护和康复领域为意识障碍(DoC)建立通用数据元素(CDE)至关重要。我们的目标是确定与DoC患者的护理目标决策以及家庭/替代决策相关的CDE。
为实现这一目标,我们作为神经重症监护协会“治愈昏迷运动”的一部分,组建了九个CDE工作组。我们专注于护理目标决策和家庭/替代决策者的工作组创建了五个子组:(1)替代者的临床变量,(2)替代者的心理困扰,(3)决策质量,(4)沟通质量,以及(5)临终护理质量。每个子组在NIH/CDE目录中搜索现有的相关CDE,并进行广泛的文献检索以推荐其他相关研究工具。我们根据“核心”、“基本”、“探索性”或“补充性”的标准定义以及它们对研究DoC急性期或慢性期或两者的效用对每个CDE进行分类。
我们在所有子组中确定了32个预先存在的相关NIH CDE。所有子组共新增了34种工具。仅一种CDE被推荐为疾病核心,即临床变量子组中患者的“死亡方式”。
我们的研究结果为DoC患者的护理目标决策以及家庭/替代决策提供了有价值的特定CDE,可用于规范研究,以在该领域开展高质量且可重复的研究。