Alexis Steinberg1, Emily Grayek2, Robert M Arnold3, Clifton Callaway4, Baruch Fischhoff5, Tamar Krishnamurti6, Deepika Mohan7, Douglas B White8, Jonathan Elmer9. 1. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: Steinberga2@upmc.edu. 2. Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA. 3. Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 4. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 5. Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA; Institute for Politics and Strategy, Carnegie Mellon University, Pittsburgh, PA, USA. 6. Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 7. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 8. Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 9. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Abstract
OBJECTIVE: Elucidate how physicians formulate a neurological prognosis after cardiac arrest and compare differences between experts and general providers. METHODS: We performed semi-structured interviews with experts in post-arrest care and general physicians. We created an initial model and interview guide based on professional society guidelines. Two authors independently coded interviews based on this initial model, then identified new topics not included in it. To describe individual physicians' cognitive approach to prognostication, we created a graphical representation. We summarized these individual "mental models" into a single overall model, as well as two models stratified by expertise. RESULTS: We performed 36 interviews (17 experts and 19 generalists), most of whom practice in Europe (23) or North America (12). Participants described their approach to prognosis formulation as complex and iterative, with sequential and repeated data acquisition, interpretation, and prognosis formulation. Eventually, this cycle results in a final prognosis and treatment recommendation. Commonly mentioned factors were diagnostic test performance, time from arrest, patient characteristics. Participants also discussed factors rarely discussed in prognostication research including physician and hospital characteristics. We found no substantial differences between experts and general physicians. CONCLUSION: Physicians' cognitive approach to neurologic prognostication is complex and influenced by many factors, including some rarely considered in current research. Understanding these processes better could inform interventions designed to aid physicians in prognostication.
OBJECTIVE: Elucidate how physicians formulate a neurological prognosis after cardiac arrest and compare differences between experts and general providers. METHODS: We performed semi-structured interviews with experts in post-arrest care and general physicians. We created an initial model and interview guide based on professional society guidelines. Two authors independently coded interviews based on this initial model, then identified new topics not included in it. To describe individual physicians' cognitive approach to prognostication, we created a graphical representation. We summarized these individual "mental models" into a single overall model, as well as two models stratified by expertise. RESULTS: We performed 36 interviews (17 experts and 19 generalists), most of whom practice in Europe (23) or North America (12). Participants described their approach to prognosis formulation as complex and iterative, with sequential and repeated data acquisition, interpretation, and prognosis formulation. Eventually, this cycle results in a final prognosis and treatment recommendation. Commonly mentioned factors were diagnostic test performance, time from arrest, patient characteristics. Participants also discussed factors rarely discussed in prognostication research including physician and hospital characteristics. We found no substantial differences between experts and general physicians. CONCLUSION: Physicians' cognitive approach to neurologic prognostication is complex and influenced by many factors, including some rarely considered in current research. Understanding these processes better could inform interventions designed to aid physicians in prognostication.
Authors: Romergryko G Geocadin; Clifton W Callaway; Ericka L Fink; Eyal Golan; David M Greer; Nerissa U Ko; Eddy Lang; Daniel J Licht; Bradley S Marino; Norma D McNair; Mary Ann Peberdy; Sarah M Perman; Daniel B Sims; Jasmeet Soar; Claudio Sandroni Journal: Circulation Date: 2019-07-11 Impact factor: 29.690