When is it appropriate to deliver a prognosis to Korean persons with acute spinal cord injury?

Abstract

Purpose: In cases of complete spinal cord injury (SCI), which has a poor probability of recovery, the timely delivery of a prognosis may be crucial to help patients adapt to their situation. The study aimed to help for choose the appropriate time for delivering a prognosis to persons with SCI. Method: Three hundred and four members of the Korean SCI Association with complete SCI were surveyed regarding the time at which their prognosis was communicated and their views about the appropriate time for prognosis delivery. Demographic and injury characteristics were also collected. Respondents’ experience and opinions on prognosis communication were analysed to assess potential associations with demographic and injury profiles. Results: Participants’ opinions regarding the time of prognosis delivery varied. Many respondents (44.1%) reported that the appropriate time would be within 1 month postinjury, whereas the others felt it should occur either between 1 and 3 months (29.3%) or more than 3 months (10.2%). The comparison of time of prognosis communication with the opinions showed that most would have preferred an earlier delivery of prognosis than they had experienced. Conclusions: Our findings provide insight to physicians on the appropriate time for delivering a prognosis to individuals with complete SCI.

Implications for Rehabilitation

• In cases of complete spinal cord injury, which has a poor probability of recovery, the timely delivery of a prognosis may be crucial to help patients adapt to their situation.

• The opinions of individuals with spinal cord injury regarding the time of prognosis delivery varied.

• The comparison of time of prognosis communication with the opinions showed that most would have preferred an earlier delivery of prognosis than they had experienced.

Keywords::

• Spinal cord injury
• prognosis
• communicate

Declaration of Interest: This work was supported by the Seoul National University Bundang Hospital, Grant number 11-2010-003.

Appendix: Contents of the questionnaire

1. Year and month of birth? () Year, () Month

2. Male or female? M (), F ()

3. What type of disability do you suffer from?

   	(1)	Complete paraplegia
   	(2)	Incomplete paraplegia
   	(3)	Complete tetraplegia
   	(4)	Incomplete tetraplegia
   	(5)	Other ( )
   	(6)	I do not know

4. What is your walking ability?

   	(1)	I cannot walk
   	(2)	I can walk a few steps with the assistance of a device (orthosis, cane, clutch, etc.)
   	(3)	I can walk at home with the assistance of a device
   	(4)	I can walk outside the home with the assistance of a device (orthosis, cane, clutch, etc.)
   	(5)	I can walk outside the home without the assistance of any device
   	(6)	Other ( )

5. When was your spinal cord injured? () Year, () Month

6. What was the cause of the spinal cord injury?

   In case of trauma ()

   	(1)	Traffic accident
   	(2)	Fall
   	(3)	Diving
   	(4)	Other sports accident
   	(5)	Assault
   	(6)	Other ( )

   In case of disease ()

   	(1)	Spinal cord tumour
   	(2)	Myelitis
   	(3)	Congenital malformation
   	(4)	Spinal tuberculosis
   	(5)	Degenerative change or spinal stenosis
   	(6)	Other ( )

7. From whom did you first hear that it would be impossible to walk?

   	(1)	Physician
   	(2)	Nurse
   	(3)	Therapist (physical, occupational, speech, etc.)
   	(4)	Family members (parents, siblings, children, etc.)
   	(5)	Friend
   	(6)	Social worker
   	(7)	Relatives (uncle, aunt, cousin, etc.)
   	(8)	I did not hear from anyone and realized it by myself
   	(9)	Other ( )

8. How long after the injury did you hear the news?

   	(1)	Within 1 month
   	(2)	Between 1 and 3 months
   	(3)	After 3 months
   	(4)	I do not remember
   	(5)	I did not hear it

9. When do you think is the appropriate time to tell the patient the truth according to the rehabilitation programme flow?

   	(1)	Before being transferred to the rehabilitation unit of the acute care hospital
   	(2)	Just after being transferred to the rehabilitation unit of the acute care hospital
   	(3)	Within 2 to 3 weeks of being transferred to the rehabilitation unit of the acute care hospital
   	(4)	Not in the rehabilitation unit of the acute care hospital
   	(5)	The physician should not disclose the inability to walk and should only encourage the patient to undergo rehabilitation
   	(6)	I do not know

10. When would be the proper time to discuss the inability to walk?

    	(1)	Within 1 month
    	(2)	Between 1 and 3 months
    	(3)	After 3 months
    	(4)	The physician should not disclose the inability to walk and should only encourage the patient to undergo rehabilitation
    	(5)	I do not know