%0 Journal Article
%T Should We Use the IMPACT
%A Jesse Moskowitz
%A Kathleen M. Mazor
%A Lori Shutter
%A Muhammad W. Khan
%A Nananda Col
%A Robert Goldberg
%A Susanne Muehlschlegel
%A Thomas Quinn
%J MDM Policy & Practice
%@ 2381-4683
%D 2018
%R 10.1177/2381468318757987
%X Introduction. Shared Decision-Making may facilitate information exchange, deliberation, and effective decision-making, but no decision aids currently exist for difficult decisions in neurocritical care patients. The International Patient Decision Aid Standards, a framework for the creation of high-quality decision aids (DA), recommends the presentation of numeric outcome and risk estimates. Efforts are underway to create a goals-of-care DA in critically-ill traumatic brain injury (ciTBI) patients. To inform its content, we examined physicians¡¯ perceptions, and use of the IMPACT-model, the most widely validated ciTBI outcome model, and explored physicians¡¯ preferences for communicating prognostic information towards families. Methods. We conducted a qualitative study using semi-structured interviews in 20 attending physicians (neurosurgery,neurocritical care,trauma,palliative care) at 7 U.S. academic medical centers. We used performed qualitative content analysis of transcribed interviews to identify major themes. Results. Only 12 physicians (60%) expressed awareness of the IMPACT-model; two stated that they ¡°barely¡± knew the model. Seven physicians indicated using the model at least some of the time in clinical practice, although none used it exclusively to derive a patient¡¯s prognosis. Four major themes emerged: the IMPACT-model is intended for research but should not be applied to individual patients; mistrust in the IMPACT-model derivation data; the IMPACT-model is helpful in reducing prognostic variability among physicians; concern that statistical models may mislead families about a patient¡¯s prognosis. Discussion: Our study identified significant variability of the awareness, perception, and use of the IMPACT-model among physicians. While many physicians prefer to avoid conveying numeric prognostic estimates with families using the IMPACT-model, several physicians thought that they ¡°ground¡± them and reduce prognostic variability among physicians. These findings may factor into the creation and implementation of future ciTBI-related DAs
%K shared decision making
%K goals-of-care decisions
%K prognosis
%K traumatic brain injury
%K critical care
%K outcomes
%K IMPACT-model
%K qualitative research
%U https://journals.sagepub.com/doi/full/10.1177/2381468318757987