How Does Functional Neurodiagnostics Inform Surrogate Decision-Making for Patients with Disorders of Consciousness? A Qualitative Interview Study with Patients' Next of Kin

Details

Serval ID
serval:BIB_71EB8E50361A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
How Does Functional Neurodiagnostics Inform Surrogate Decision-Making for Patients with Disorders of Consciousness? A Qualitative Interview Study with Patients' Next of Kin
Journal
Neuroethics
Author(s)
Schembs Leah, Ruhfass Maria, Racine Eric, Jox Ralf J., Bender Andreas, Rosenfelder Martin, Kuehlmeyer Katja
ISSN
1874-5490
1874-5504
Publication state
In Press
Language
english
Abstract
Background Functional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome (UWS) and the minimally conscious state (MCS). It remains unclear how it informs surrogate decision-making. Objective To explore how the next of kin of patients with disorders of consciousness (DOC) interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions. Methods and Sample We conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis. Results Regardless of the diagnostic results, all participants were optimistic of the patients' meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient's state (e.g., a "negative" HD-EEG-result) had the potential to destabilize the participant's belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a "positive" HD-EEG result since it stabilized their belief system. Conclusion We hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result's value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions.
Keywords
Health Policy, Neurology, Psychiatry and Mental health
Web of science
Create date
20/10/2020 9:04
Last modification date
21/10/2020 5:28
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