Differing perspectives on outcome after subarachnoid hemorrhage: the patient, the relative, the neurosurgeon.

OBJECTIVE: To better understand patients' and relatives' views of outcome after surgery for subarachnoid hemorrhage (SAH), we evaluated neurobehavioral changes, psychological distress, and family burden of patients who had been considered by their neurosurgeon as having a "good recovery" or a "moderate disability," as rated on the Glasgow Outcome Scale.
METHODS: A heterogeneous sample of 28 patients treated surgically for SAH from an aneurysm or an arteriovenous malformation and their relatives separately underwent a semistructured interview. They also completed a revised version of the Adjective Checklist to assess their perceptions of the patient's neurobehavioral changes and the Brief Symptom Inventory as a measure of their own psychological distress. Levels of family burden on the relatives were evaluated with a Likert strain scale and the Zarit Burden Interview.
RESULTS: Approximately 19 months after surgery for SAH, the majority of the patients reported significant negative neurobehavioral changes and negative changes in employment, energy levels, tolerance to mild stressors, leisure activities, and social and sexual relationships. Patients and relatives both reported elevated levels of psychological distress, and the relatives reported elevated levels of family burden. Patients' and relatives' perceptions differed, with the relatives reporting more problems; both viewed the patient's outcome more negatively than did the operating neurosurgeon.
CONCLUSION: Despite the neurosurgeon's classification of patients as having a "good recovery" or "moderate disability," the majority of patients surgically treated for SAH reported psychosocial and neurobehavioral changes that were disabling for them and burdensome to their family. Patients and relatives who are interviewed separately by an experienced clinician may provide differing perspectives on SAH outcome that are not necessarily good.