With the aging of the population and advances in medical technology, families are increasingly asked to make decisions regarding the end-of-life care of older loved-ones with critical illness. Intracerebral hemorrhage (ICH) is a common and severe type of stroke with a high risk of early mortality, though good functional recovery is possible in some survivors. The decision to pursue either full intensive or comfort care occurs very early during the course of ICH treatment, with one-third of ICH patients having a do-not-resuscitate (DNR) order written within the first 24 hours. There is significant variability in use of DNR orders and withdrawal of life sustaining treatment after ICH. Many factors likely drive this variability, including family values and belief systems, pre- existing illness, physician's estimate of prognosis and the family's understanding of the prognosis. The rapid onset of symptoms, reliance on surrogate decision makers, uncertain prognosis, and early nature of the decisions suggest that the process of end-of-life decision making after ICH is likely to be distinct from that of other conditions. The long-term goal of this career development award is to promote the candidate's development into a clinical and research leader working to improve the process of end-of-life decision making in acute neurological disease.
The aims of this project are 1) To assess determinants of variability in physician prognostic estimates and recommendations to withdraw life sustaining treatment 2) To describe the factors that influence surrogate end-of-life decisions about ICH and their satisfaction and regret surrounding these decisions;and 3) To identify modifiable determinants of surrogate decisional satisfaction and decisional regret surrounding ICH end-of-life care. This project will combine a national survey of physicians with interviews and surveys of surrogate decision makers from two distinct health care systems in order to understand the process of end-of-life decision making after ICH from the perspective of the physician and the family. The candidate is committed to a career as a rigorously trained clinical investigator and requires additional training in order to accomplish his long term goal of improving end-of-life care for older individuals facing acute neurological disease. A detailed career development plan will promote the candidate's development of expertise in decision science, qualitative and mixed-methods research, advanced quantitative analysis, as well as palliative and end-of-life care. The career development plan consists of a multidisciplinary team of experienced mentors and advisors who will oversee a range of formal coursework and practical experiences in these areas to ensure the candidate's future success. Superb resources of a top university and a mentoring team with demonstrated success in developing junior investigators in these topic areas makes the University of Michigan an ideal environment for this project.

Public Health Relevance

Making decisions about the medical care of a loved-one with acute brain hemorrhage is a difficult and frightening time for families. This project will work to improve the processes that doctors and families use to make these decisions in the future.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG038731-02
Application #
8321466
Study Section
National Institute on Aging Initial Review Group (NIA)
Program Officer
Nielsen, Lisbeth
Project Start
2011-09-01
Project End
2016-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
2
Fiscal Year
2012
Total Cost
$159,060
Indirect Cost
$11,560
Name
University of Michigan Ann Arbor
Department
Neurology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
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Camaj, Anton; Zahuranec, Darin B; Paone, Gaetano et al. (2017) Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan. Anesth Analg 125:975-980
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Wing, Jeffrey J; Baek, Jonggyu; Sánchez, Brisa N et al. (2014) Differences in initial stroke severity between Mexican Americans and non-Hispanic whites vary by age: the Brain Attack Surveillance in Corpus Christi (BASIC) project. Cerebrovasc Dis 38:362-9

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