Abstract TP82: Factors Associated With Trainee Burden In Post-stroke Goals Of Care Meetings

Abstract

Introduction: Goals of care discussions with patients or surrogates are a crucial part of inpatient care. Explaining neurological diagnoses, functional outcomes, and prognoses can be challenging. We surveyed trainees regarding factors associated with burden in goals of care meetings. Methods: An anonymous online survey was sent to neurology and neurosurgery trainees at the Los Angeles County + University of Southern California and Vanderbilt University Medical Centers. The survey inquired awareness of hospice criteria, reliance on verbal communication, moral injury (sense of futility, helplessness, or densensitization), need for preparing surrogate decision makers, and factors associated with burden using a 5-point Likert scale. Proportions of responses with agree or strongly agree were calculated. Results: 22 out of 69 residents (31.9%) filled out the survey. 36.4% were aware of any stroke-specific hospice criteria. 86.4% felt physician’s communication skill the most important factor for a constructive goals of care meeting. 36.4% felt neurologists and neurosurgeons relied too much on verbal communication to explain neurological deficits and prognosis. 40.9% felt moral injury during goals of care discussions. 77.3% felt that the patients or surrogate decision makers need to be more prepared. 27.2% felt underprepared for goals of care meetings. Top three factors of burden were time (86.4%), redundancy in explaining (81.8%), and lack of health literacy in patients or surrogates (77.3%). Most helpful factors were a team member who speaks the same language (72.7%), delivering poor prognosis upfront when applicable (68.2%), and frequent bedside updates (54.5%). 90.9% wished there was a customized goals of care planning resource for the surrogates prior to the formal meeting. Conclusions: Majority of trainees found communication and language the most helpful factors for goals of care meetings. Meanwhile, time, redundancy, and lack of health literacy among patients and surrogates were top factors of burden. Majority also felt that patients or surrogates needed to be better prepared and wished for customized resources prior to the meetings. Customized resource might help improve the quality of goals of care discussions and decrease trainee burden.