Abstract Details

Title Brain Computer Interface Technology Impacts Physician Perspectives on Prognostication and ICU Decision Making in Patients With Stroke and Traumatic Brain Injury

Topic Practice, Policy, and Ethics

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 14-001

Objective To evaluate the impact of brain computer interface (BCI) technology as a speech and motor prosthesis on physician perspectives about acute decision making for patients with stroke and traumatic brain injury (TBI).

Background Disability after stroke and TBI is pervasive; over 600,000 patients become newly disabled every year from these conditions. The availability of BCI to mitigate the impact of disabilities may affect how stakeholders consider prognosis and long-term outcomes, and in turn may impact decision-making in the neurocritical care setting. Thus there is an un-met need to evaluate the implications of BCI technology for the physicians caring for these patients.

Design/Methods We conducted semi-structured interviews with 50 physicians to explore experiences related to BCI. Interviews were audio-recorded, transcribed verbatim, and de-identified. A codebook was created using an inductive iterative approach. Two researchers coded all transcripts using Dedoose software, with a third coder involved in weekly meetings to reach consensus. Coded data were summarized to highlight key points and illustrative quotes, facilitating comparison across participants. Final analysis resulted in theme development around prognostic impact and physician concerns.

Results Physician specialties included critical care (29, 58%), neurology (15, 30%), and other (6, 12%). Most practiced in academic settings (40, 80%). Physicians had contrasting views on how BCI would impact acute prognostication. Two prognostic themes emerged: 1) that BCI would change prognostication on patients that typically would have been predicted to have minimal improvements in motor or speech function after injury; or 2) no change in prognostication in the acute phase given significant uncertainties and limitations in prognosticating in this setting. Additional themes identified physician concerns about how BCI would influence surrogate opinions about disability and decision-making about supportive interventions like tracheostomy and gastrostomy.

Conclusions

Physicians had varying views on how BCI would impact acute decision-making for patients with acquired brain injury from stroke and TBI.

Authors/Disclosures
Arely Campos-Melendez PRESENTER	Miss Campos-Melendez has nothing to disclose.
Karen Hirsch, MD (Stanford University)	The institution of Dr. Hirsch has received research support from National Institutes of Health.
Krysta Barton, PhD	Dr. Barton has nothing to disclose.
Elizabeth O. Pernicka, BS	Mrs. Pernicka has nothing to disclose.
Sydney Walls	Miss Walls has nothing to disclose.
Holly K. Tabor, PhD	An immediate family member of Dr. Tabor has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Special Olympics Northern California. An immediate family member of Dr. Tabor has stock in IDD Empower AI LLC. The institution of Dr. Tabor has received research support from NIH. The institution of Dr. Tabor has received research support from WITH Foundation. The institution of Dr. Tabor has received research support from NIH.