TY - JOUR
T1 - International survey on the implementation of the European and American guidelines on disorders of consciousness
AU - Farisco, Michele
AU - Formisano, Rita
AU - Gosseries, Olivia
AU - Kato, Yoko
AU - Koboyashi, Shigeki
AU - Laureys, Steven
AU - Lejeune, Nicolas
AU - Martial, Charlotte
AU - Matar, Amal
AU - Morrisey, Ann Marie
AU - Schnakers, Caroline
AU - Yakufujiang, Maidinamu
AU - Yamaki, Tomohiro
AU - Veeramuthu, Vigneswaran
AU - Zandalasini, Matteo
AU - Zasler, Nathan
AU - Magliacano, Alfonso
AU - Estraneo, Anna
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2024/1
Y1 - 2024/1
N2 - Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients’ families/representatives.
AB - Diagnostic, prognostic, and therapeutic procedures for patients with prolonged disorders of consciousness (pDoCs) vary significantly across countries and clinical settings, likely due to organizational factors (e.g., research vs. non-academic hospitals), expertise and availability of resources (e.g., financial and human). Two international guidelines, one from the European Academy of Neurology (EAN) and one from the American Academy of Neurology (AAN) in collaboration with the American Congress of Rehabilitation Medicine (ACRM) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), were developed to facilitate consistent practice among professionals working with this challenging patient population. While the recommendations of both guidelines agree in principle, it remains an open issue how to implement them into clinical practice in the care pathway for patients with pDoCs. We conducted an online survey to explore health professional clinical practices related to the management of patients with pDoCs, and compare said practices with selected recommendations from both the guidelines. The survey revealed that while some recommendations are being followed, others are not and/or may require more honing/specificity to enhance their clinical utility. Particular attention should be given to the implementation of a multimodal assessment of residual consciousness, to the detection and treatment of pain, and to the impact of restrictions imposed by COVID-19 pandemics on the involvement of patients’ families/representatives.
KW - Bioethics
KW - Clinical guidelines
KW - Cognitive–motor dissociation
KW - Coma
KW - Disorders of consciousness
KW - Ethics
KW - Minimally conscious state
KW - Neuroethics
KW - Unresponsive wakefulness syndrome
KW - Vegetative states
UR - http://www.scopus.com/inward/record.url?scp=85172005196&partnerID=8YFLogxK
U2 - 10.1007/s00415-023-11956-z
DO - 10.1007/s00415-023-11956-z
M3 - Article
C2 - 37740739
AN - SCOPUS:85172005196
SN - 0340-5354
VL - 271
SP - 395
EP - 407
JO - Journal of Neurology
JF - Journal of Neurology
IS - 1
ER -