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Susanne Muehlschlegel, MD, MPH, cares for critically ill patients who have suffered grave brain injuries from trauma, stroke and other diseases. They are unable to communicate or make decisions on their own behalf.
That is why Dr. Muehlschlegel, associate professor of neurology, cares as much about communicating with family members as treating the patients. The physician-scientist has established a research program at UMass Medical School that focuses on helping families navigate difficult decisions in times of uncertainty and stress.
“My family-centered research in the neuro-ICU is focused on improving communication between families and physicians by employing shared decision making,” said Muehlschlegel. “Shared decision making occurs when families and physicians make health care decisions together by considering the best scientific evidence available, the patient’s values and preferences, and the doctors’ expert opinions.”
While improved resuscitation methods and advances in critical care have significantly increased the survival of patients with devastating brain injuries, their long-term prognoses can be uncertain. Once a patient in the ICU is stabilized, their families are faced with decisions about what to do next: whether to continue aggressive treatment with the goal to get them to rehabilitative care, or simply provide comfort care.
“The immediate goal of our research is to create and design decision aids, which are shared decision making tools. We work hand-in-hand with families to have them give us input and feedback on the tools that we develop,” said Muehlschlegel. “We have recently designed three different decision aids for goals-of-care decisions in traumatic brain injury, acute ischemic stroke and intracerebral hemorrhage, and are now testing them for feasibility with families in the neuro-ICU as they face these morally difficult decisions.”
The ultimate goal is to decrease potential regret about the decisions made, whether they are to withdraw care or prolong care despite a futile outlook for the patient’s quality of life, she said. “Many surrogates suffer from psychological consequences because of their decision, such as anxiety, depression, even PTSD and decision regret, and we’re trying to decrease that,” Muehlschlegel said. “We’re hoping to increase the engagement of families and empower them to make a decision that is the right decision for their loved one: the decision the patient would choose for themselves.”
She is also researching how to better predict the prognosis for moderate to severely brain-injured patients, as better prognosis will help inform better care decisions. Additional studies underway in her neurocritical care research program aim to find new clinical treatments for patients with catastrophic neurological emergencies.
All neurocritical care research under her direction shares the overarching goal to improve the care of critically ill neurologic emergency patients with cutting edge population research, clinical trials and qualitative research. Muehlschlegel’s lab strives to cultivate a shared passion for neurocritical care by mentoring medical students, residents, fellows and visiting research scholars.
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