July 1, 2014

Willingness to Favor Aggressive Care and Live with Disability Following Severe Traumatic Brain Injury: A Survey of Healthy Young Adults in Hawai‘i

Kazuma Nakagawa M.D. and Kyle K. Obana

Hawai‘i Journal of Medicine & Public Health

Traumatic brain injury (TBI) is a major public health problem that significantly impacts young adults. Since severe TBI patients lack decision-making capacity, the providers and patient surrogates are often faced with the challenging task of deciding whether to continue with aggressive life-prolonging care or to transition to comfort-focused care with an expected outcome of natural death. The assumption is often made that aggressive care is appropriate for young patients who suffer severe TBI despite the high likelihood of a poor outcome. However, the young community’s attitude towards goals of care after severe TBI has not been studied. A questionnaire-based survey study on young healthy adults was conducted to assess their attitude towards aggressive care after a hypothetical case of severe TBI. Logistic regression analysis was performed to determine the factors associated with the decision to favor aggressive care. Among a total of 120 community-dwelling young adults (mean age: 19±1 years) who were surveyed, 79 (66%) were willing to live with severe motor disability, 78 (65%) were willing to live with expressive aphasia, and 53 (44%) were willing to live with receptive aphasia. Despite being presented with a high likelihood of long-term moderately severe-to-severe disability, 65 of the 115 respondents (57%) favored aggressive care. A willingness to live with receptive aphasia was the only independent factor that predicted aggressive care (OR 2.50, 95% CI: 1.15 to 5.46). Even among the young adults, preference of care was divided between aggressive and conservative approaches when presented with a hypothetical case of severe TBI.

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