Disclosures: Emily R. Marquez, MD: No financial relationships or conflicts of interest

Case Description: Patient experienced an out of hospital cardiac arrest with resultant fall in which he sustained bilateral vertebral artery dissections, large left posterior cerebellar artery infarction, and cervical spine fractures. Surgical stabilization of cervical fractures was precluded by vertebral dissections, though patient would require numerous additional interventions in order to sustain life. The patient had severe cognitive, communication, and mobility impairments as a result of his injuries and was therefore unable to participate in medical decision-making. A suitable surrogate could not be found among the patient’s family. Physiatry was consulted to offer expertise in communication, with the goal of patient being able to direct his continued care. Physiatry attempted numerous methods of establishing verbal and/or non-verbal communication. Physiatry also suggested consultation of a Speech-Language Pathologist (SLP), a consistent communication system between providers that did not involve reflexive responses, and offered valuable insight on the functional prognosis of the patient.

Setting: Acute Care Hospital

Patient: 73-year-old male with comminuted displaced fractures of the odontoid process of C2 and arches of C1 and bilateral vertebral artery dissections following cardiac arrest and fall. Assessment/

Results: Despite repeated Physiatry and SLP evaluations, functional means of communication could not be established. Ultimately, a court-appointed guardian made the decision to withdraw mechanical ventilatory support. This was in alignment with patient’s previously communicated goals and values as conveyed by his family.

Discussion: Shared decision-making is the cornerstone of patient-centered care. Physiatrists are experts at developing functional goals based on a patient’s values and preferences and utilize a unique interdisciplinary approach. In this case, this expertise was sought out to aid a patient who was unable to convey their wishes.

Conclusion: Physiatrists’ interdisciplinary approach and expertise at establishing functional goals are valuable additions to medical decision-making at end of life.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-interdisciplinary-approach-to-communication-at-end-of-life-a-case-report/