Medical complications and advanced medical decision-making in the minimally conscious state.
Overbeek, B.U.H., van Erp, W.S., Eilander, H.J., Koopmans, R.T.C.M., & Lavrijsen, J.C.M.
12 November 2024Abstract
Objectives
Medical complications are common in MCS and affect prior medical decision-making. This study aimed to report on medical complications and promote medical decision-making in a national group of MCS patients.
Methods
In this descriptive cross-sectional study, clinical and advanced medical decision-making characteristics were collected in a survey, completed by the treating physician.
Results
The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% males. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) were the most common. Most patients had curative goals: three patients had a fully curative treatment scenario, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about prior medical decision-making were complicated by disputes with bereaved relatives, the inability to evaluate medical treatment due to medical instability, bereaved people who were not ready to discuss medical treatment, or a treatment scenario that was explicitly based on bereaved requests.
Conclusion
Medical complications are common in MCS patients, and the prior medical decision-making process was complicated. This legitimizes the realization of specialized care in acute, post-acute and long-term care. Further longitudinal research on advanced medical decision-making is recommended.
