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.

中文翻译：

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功能性神经诊断学如何为意识障碍患者的替代决策提供信息？与患者近亲的定性访谈研究

背景

功能神经诊断学可以让研究人员和临床医生更准确地区分无反应觉醒综合征 (UWS) 和最低意识状态 (MCS)。目前尚不清楚它如何为代理决策提供信息。

客观的

探讨意识障碍 (DOC) 患者的近亲如何解释功能性神经诊断测量的结果，以及他们的解释如何/为什么影响他们对医疗决策的态度。

方法和样品

我们对 7 名在德国神经康复中心接受功能性 HD-EEG 检查的 DOC 患者的近亲进行了以问题为中心的访谈。检查包括听觉古怪范式和运动意象任务，以检测隐藏的意识。我们使用结构化定性内容分析来分析访谈记录。

结果

无论诊断结果如何，所有参与者都对患者的有意义康复持乐观态度。我们假设，参与者根据他们的信念系统处理考试结果。因此，对患者状态的不利评估（例如，“阴性”HD-EEG 结果）有可能破坏参与者的信念系统。为了重新稳定或防止他们的信仰体系不稳定，参与者使用了不同的策略。参与者接受了“积极”的 HD-EEG 结果，因为它稳定了他们的信念系统。

结论

我们假设，一组 DOC 患者的近亲根据结果的价值和他们对患者有意义地康复的高度希望来处理功能性神经诊断结果。一种心理机制似乎可以缓和功能性神经诊断学对替代治疗决策的影响。