Education to Improve Understanding of Ethical and Communication Issues Around Disorders of Consciousness

Background Disorders of consciousness are a classification of neurological syndromes that involve the disruption of wakefulness and/or awareness. Coma, minimally conscious state, and persistent vegetative state are the main categories within the spectrum of disorders of consciousness, each with distinct characteristics and associated ethical dilemmas. We investigated whether administering an educational intervention to medical residents, fellows, and students would improve the understanding of and confidence in approaching the diagnostic, communicative, and ethical complexities related to disorders of consciousness. Methods A 1-hour educational session covering ethical and communication challenges related to medical decision making for patients with disorders of consciousness was administered to residents, fellows and students at Corewell Health William Beaumont University Hospital. Participants completed a questionnaire containing a Likert scale before and after the intervention assessing their confidence in approaching diagnosis, treating, ethical challenges, and communication practices between both patients and surrogate decision makers for patients with various disorders of consciousness. Change in confidence was analyzed using Shapiro-Wilk tests to determine skew and Wilcoxon signed-rank test to compare pre and post intervention scores. Results A total of 23 trainees participated from July to December 2024. After the educational training session, trainees were more confident (p < .01) .describing standard kinds of disorders of consciousness and their behavioral differences, understanding the diagnostic error rate, challenges, and fMRI studies detecting covert awareness, understanding the “window of opportunity” and the challenge of clinical nihilism among those recovering from TBI, and in their ability to communicate appropriately with surrogates about brain injury and with patients in a minimally conscious state. Conclusions Medical decision making for patients with disorders of consciousness is fraught with ethical and communication challenges. These findings support the use and delivery of 1-hour targeted educational interventions to better prepare medical trainees for future encounters with families and patients with a disorder of consciousness. Trial Registration Oakland University IRB-FY2025-4 – Category 2 Exempt Decision