Table 2.

Representative quotes of Key Themes Addressed in Palliative Care Consultations for Neuro-ICU patients

Clinical Issue	Representative quote
Discussing Prognosis	“[The husband] says he has been told that the stroke is serious and that it is highly unlikely that [the patient] would return to her prior baseline, and that she would most likely be in a nursing home dependent on some, if not all of her [activities of daily living], that if she recovers it would be slow over months, and uncertain as to how much independence she would regain.” “His prognosis is uncertain, but per neurosurgery will certainly involve a L hemiplegia and likely more debilitating deficits.”
Eliciting Patient Values	“His brother states that [he] values his ability to talk with others and this clearly brought his life a lot of joy and meaning. [The patient] had to be the "life of the party" and had so many friends. He enjoyed company and joined a church at one point not because of his religious beliefs but because of the sense of community that came with it.” “[He] was very clear that what is most important is his independence [and] he was only willing to undergo medical care, including brief intubation, if it would be enable him to live independently.”
Eliciting Family Values	“Role of Faith/Spirituality/Religion: Their spirituality is paramount and a way of life. Meditation and prayer take place throughout the day. The word ‘please’ is the most important word to them. They pray and express their thanks throughout the day, from thanking the vegetables that they eat for allowing them to sustain life to thanking the providers here. They pray for us, our health, and our children that we will not be in a similar situation as them, and they pray for the safety of healthcare workers when they drive by a hospital.” “Also pointed out that putting [the patient] back on the ventilator would be to relieve [the family’s] suffering, not [the patient’s], and this is not in line with what they ultimately want for her, which is to allow her to pass peacefully and not to prolong her suffering with the ventilator.”
Understanding Medical Options	“[Husband] is articulate as he describes a 'sobering prognosis' from Dr. ___. He clearly understands the severity of [patient]'s injury, explains potential complications, and recounts best case/worst case scenarios. “ “We had a long conversation about his prognosis and treatment options and discussed 3 potential paths 1) continue current aggressive care including trach and long term vent if needed 2) Trial of getting him off the vent, but if he fails again then move to comfort care or 3) move to comfort care now. She wanted to talk with other family members and needs time to think about things. We emphasized there was not any pressure on her to make a decision right now…”
Identifying conflict	“[The husband] is aware that her parents would like all treatment to continue. They have been hostile to the idea of shifting the focus to comfort care and they would not speak [to the] palliative care team when we attempted to speak with them, although they did tell us ‘the doctors want to pull the plug…’” “Both [names of family members] understand their sister's injuries, however they both say they are struggling with receiving conflicting information re prognosis.”