title: Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention.
abstract: BACKGROUND
  Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI). This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI.
  
  
  METHODS
  A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios.
  
  
  RESULTS
  Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6), especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants.
  
  
  CONCLUSIONS
  Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.
authors.affiliation: Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia. stephen.honeybul@health.wa.gov.au
authors.forename: Stephen
authors.initials: S
authors.lastname: Honeybul
authors.forename: Kwok
authors.initials: K
authors.lastname: Ho
authors.forename: Susan
authors.initials: S
authors.lastname: O'Hanlon
mesh_terms: D022126:Access to Information; D000063:Accidents, Traffic; D000328:Adult; D001930:Brain Injuries / Q000601:surgery*; D003657:Decision Making; D056424:Decompressive Craniectomy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D015203:Reproducibility of Results; D012306:Risk; D016896:Treatment Outcome