Determination of Brain Death and Family Communication Physician Training Program
Demographic and Pre-Training Survey Questions
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First Name
Last Name
Email
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Your responses to the study questionnaire are confidential. Gift of Life Institute and Penn Medicine are committed to protecting your confidential data. You will be assigned a unique identifier to be used in reports and data analysis. Your name or any other identifying information will not be used in reports or publications resulting from this study. We will stop using your information at the conclusion of the study. You may contact us with questions and/or withdraw permission for us to use your information for this research study at any time by sending an email to Theresa A. Daly, Sr. Director at Gift of Life Institute at tdaly@giftoflifeinstitute.org. You may copy and paste this link to view the Consent Form - https://www.giftoflifeinstitute.org/wp-content/uploads/2023/01/Final-Participant-Full-Consent-Form-3.pdf. You may save or print a copy for your records.
I have read the above Consent for Use/Disclosure required to participate in the "Determination of Brain Death and Family Communication Physician Training Program" research study.
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Yes, I elect to participate in the research
No, I do not elect to participate in the research
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If you have any questions, please email info@giftoflifeinstitute.org. We will respond within 24 hours. Thank you, Gift of Life Institute
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Which category below includes your age? (Please choose only one.)
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18-29
30-39
40-49
50-59
60-69
70 or older
How do you identify? (Please choose only one.)
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Male
Non-binary
Female
Prefer not to answer
Prefer to self-describe:
Which race or ethnicity best describes you? (Please choose only one.)
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American Indian or Alaskan Native
Asian / Pacific Islander
Black or African American
Hispanic
White / Caucasian
Prefer not to answer
Multiple ethnicity / Other (Please specify.)
What is your degree? (Select all that apply.)
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MD/DO
NP/DNP
PA
Ph.D.
Other (Please specify.)
What was your primary medical residency training? (Select all that apply.)
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Medicine
Emergency Medicine
Surgery
Neurology
Neurosurgery
Pediatrics
Anesthesia
Other (Please specify.)
Did you do a fellowship in Critical Care?
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Yes
No
In what area of Critical Care (CC) did you complete your fellowship training?
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Surgical or Anesthesia or Trauma CC
Pulmonary or Medical CC
Neuro CC
Cardiac Medical or Surgical CC
What is your primary site of clinical practice?
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ICU
Outpatient Clinic
ER
OR
Floor/Ward
DO WE NEED THIS??What is your current medical environment:
Medical ICU
Surgical ICU
Both
What is your current specialty? (Select all that apply.)
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Medicine
Emergency Medicine
Critical Care
Surgery
Neurology
Pediatrics
Anesthesia
Neurosurgery
Other (Please specify.)
If you selected Critical Care above, is that:
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Medical
Surgical
Both
How frequently do you perform brain death determination exams? (Please choose only one.)
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Never
< 3 times/per year
3-5 times/year
6-10 times/year
More than 10 times/year
When was the last time you performed a brain death examination? (Please choose only one.)
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Never
< 3 months ago
3-6 months ago
6-12 months ago
1-2 years ago
2-4 years ago
> 4 years ago
How frequently do you interact with an organ procurement organization (OPO) professional? (Please choose only one.)
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Never
< 3 times/year
3-5 times/year
6-10 times/year
More than 10 times/year
How many years have you been in practice since the end of your training? (Please choose only one.)
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< 1 year
1-5 years
6-10 years
11-20 years
> 20 years
What type of affiliation/s does the hospital you practice in have? (Please choose only one.)
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Academic
Non-Academic
Community
Other (Please specify.)
What state do you primarily practice in? (Please choose only one.)
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Please Select
Delaware
New Jersey
Pennsylvania
Please select the Delaware hospital you primarily practice in. (Please choose only one.)
Please Select
Nemours Children’s Health
Bayhealth Hospital - Kent Campus
Bayhealth Hospital – Sussex Campus
Beebe Medical Center
Christiana Hospital
Delaware Veterans Administration Medical Center
St. Francis Hospital
TidalHealth Nanticoke
Wilmington Hospital
Please select the New Jersey hospital you primarily practice in. (Please choose only one.)
Please Select
AtlantiCare Regional Medical Center - Atlantic City Campus
AtlantiCare Regional Medical Center - Mainland Campus
Cape Regional Medical Center
Deborah Heart & Lung Center
Inspira Medical Center Elmer
Inspira Medical Center Mullica Hill
Inspira Medical Center Vineland
Jefferson Cherry Hill Hospital
Jefferson Stratford Hospital
Jefferson Washington Township Hospital
Salem Medical Center
Shore Medical Center
Southern Ocean Medical Center
Virtua Marlton Hospital
Virtua Mount Holly Hospital
Virtua Voorhees Hospital
Virtua Willingboro Hospital
Please select the Pennsylvania hospital you primarily practice in. (Please choose only one.)
Please Select
Abington Hospital – Jefferson Health
Abington – Lansdale Hospital – Jefferson Health
Barnes-Kasson County Hospital
Berwick Hospital Center
Bryn Mawr Hospital
Chester County Hospital
Chestnut Hill Hospital
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia King of Prussia Campus
Corporal Michael J. Crescenz VA Medical Center
Crozer-Chester Medical Center
Delaware County Memorial Hospital
Doylestown Hospital
Einstein Medical Center Elkins Park
Einstein Medical Center Montgomery
Einstein Medical Center Philadelphia
Endless Mountains Health Systems
Evangelical Community Hospital
Geisinger Bloomsburg Hospital
Geisinger Community Medical Center
Geisinger Jersey Shore Hospital
Geisinger Lewistown Hospital
Geisinger Medical Center
Geisinger Medical Center Muncy
Geisinger Shamokin Area Community Hospital
Geisinger St. Luke's
Geisinger Wyoming Valley Medical Center
Grand View Hospital
Guthrie Towanda Memorial Hospital
Holy Redeemer Hospital
Hospital of the University of Pennsylvania
Hospital of the University of Pennsylvania - Cedar Avenue
Jeanes Hospital
Jefferson Bucks Hospital
Jefferson Frankford Hospital
Jefferson Hospital For Neuroscience
Jefferson Torresdale Hospital
Lancaster General Hospital
Lankenau Medical Center
Lebanon Veterans Administration Medical Center
Lehigh Valley Hospital - Hazleton
Lehigh Valley Hospital - Muhlenberg
Lehigh Valley Hospital – Pocono
Lehigh Valley Hospital - Schuylkill East Norwegian Street
Lehigh Valley Hospital-Cedar Crest
Lehigh Valley Hospital-Dickson City
Lower Bucks Hospital
Mercy Catholic Medical Center- Mercy Fitzgerald Campus
Methodist Hospital
Moses Taylor Hospital
Mount Nittany Medical Center
Nazareth Hospital
Paoli Hospital
Penn Presbyterian Medical Center
Penn State Health Hampden Medical Center
Penn State Health St. Joseph
Penn State Milton S. Hershey Medical Center
Pennsylvania Hospital
Phoenixville Hospital
Pottstown Hospital
PSH Holy Spirit Medical Center
Reading Hospital
Regional Hospital Of Scranton
Riddle Hospital
Roxborough Memorial Hospital
Springfield Hospital
St. Christopher's Hospital For Children
St. Luke’s Carbon Campus
St. Luke’s Sacred Heart Campus
St. Luke's Easton Campus
St. Luke's Hospital- Monroe Campus
St. Luke's University Hospital - Allentown Campus
St. Luke's University Hospital - Anderson Campus
St. Luke's University Hospital - Bethlehem
St. Luke's University Hospital - Miners Campus
St. Luke's Upper Bucks Hospital
St. Mary Medical Center
Suburban Community Hospital
Taylor Hospital
Temple University Hospital
Thomas Jefferson University Hospital
UPMC Carlisle
UPMC Community Osteopathic
UPMC Hanover
UPMC Harrisburg
UPMC Lititz
UPMC Lock Haven
UPMC Memorial
UPMC West Shore
UPMC Williamsport
UPMC Williamsport Divine Providence Campus
Wayne Memorial Hospital
WellSpan Ephrata Community Hospital
WellSpan Gettysburg Hospital
WellSpan Good Samaritan Hospital
WellSpan Waynesboro Hospital
WellSpan York Hospital
Wilkes-Barre General Hospital
Wilkes-Barre Veterans Administration Medical Center
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Have you had any prior training in performing brain death determination?
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Yes
No
If yes, when did this occur? (Select all that apply.)
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Medical school
Residency
Fellowship
Post-training
Other (Please specify.)
Have you had any prior training in how to prepare a family for, and how to deliver bad news?
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Yes
No
If yes, when did this occur? (Select all that apply.)
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Medical school
Residency
Fellowship
Post-training
Other (Please specify.)
Have you had any prior training in how to prepare a family for, and how to deliver news of brain death?
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Yes
No
If yes, when did this occur? (Select all that apply.)
Medical school
Residency
Post-residency
Other (Please specify.)
A family's ability to comprehend brain death is based on: (Select all that apply.)
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How well they have been prepared
Consistency of messaging they receive from the healthcare team
Using medical terminiology to describe the brain death exam and apnea test
Using frequent open-ended questions to check for understanding
Encouraging hope until the neurological exam and apnea test confirm brain death
If a patient clinically appears brain dead and a cause has not yet been identified, one should proceed with brain death testing.
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True
False
When a patient is pronounced brain dead, they are medically and legally dead.
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True
False
After pronouncing death, you must obtain a withdrawal decision from the patient's family in order to remove the endotracheal tube and discontinue ventilatory support.
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True
False
Which of the following are NOT consistent with brain death? (Select all that apply.)
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Spontaneous breathing
Minimal response to painful stimuli
Intact brainstem reflexes
Spinally mediated reflexes
Consensual pupillary response to light
When assessing the sucking reflex in an infant, any observed sucking response is NOT consistent with brain death.
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True
False
I am confident in my knowledge of how to perform the physical act of conducting a brain death examination. (Please choose only one.)
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Strongly agree
Agree
Neither disagree nor agree
Disagree
Strongly disagree
I am confident in my ability to prepare families to receive the news I will deliver after the determination of brain death is complete. (Please choose only one.)
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Strongly agree
Agree
Neither disagree nor agree
Disagree
Strongly disagree
I am confident in my ability to prepare families to comprehend the news I will deliver after the determination of brain death is complete. (Please choose only one.)
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Strongly agree
Agree
Neither disagree nor agree
Disagree
Strongly disagree
I am confident in my ability to deliver news to a patient's family that the brain death examination is complete and confirms the patient has died. (Please choose only one.)
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Strongly agree
Agree
Neither disagree nor agree
Disagree
Strongly disagree
I am confident in my ability to talk with families about all aspects of the brain death examination. (Please choose only one.)
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Strongly agree
Agree
Neither disagree nor agree
Disagree
Strongly disagree
Prior to initiating brain death determination, which of the following must be done? (Select all that apply.)
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Rule out significant levels of sedatives/paralytic medications
Correct hypothermia
Correct severe metabolic abnormalities
Correct hypoxemia
Perform an ancillary study (i.e., EEG, nuclear blood flow)
To assess the oculovestibular reflex, which of the following are necessary? (Select all that apply.)
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The head of the bed should be angled at 30 degrees
Provider must ensure the tympanic membrane is intact
50 cc's of warm water should be prepared
After injecting the water/saline, wait 10 minutes
Testing of either the left ear or right ear is sufficient
With respect to pupillary light reflex testing, which of the following are consistent with brain death? (Select all that apply.)
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Pupils are mid-position
Pupils are pinpoint
No response when a light is shined directly into either eye
There is a consensual response when a light is shined in the opposite eye
Pupils react very sluggishly
Which of the following responses are inconsistent with brain death? (Select all that apply.)
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Babinksi sign
Triple flexion
Facial grimace
Undulating toe
Extensor posturing
Of the following, which are pre-requisites to performing an apnea test? (Select all that apply.)
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Ensure patient is not hypoxemic and MAP >75 (with/without pressors)
Determine whether patient has baseline C02 retention
Adjust ventilator to achieve a PaC02 between 35-45mmHg and pH (7.35-7.45)
Pre-oxygenate for at least 40 minutes with 100% FiO2, with goal of obtaining PaCO2 > 200mmHg
Assure the respiratory therapist is available in the hospital should you need them during the test
Of the following, what should be considered during the apnea test? (Select all that apply.)
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Equipment necessary for resuscitation should be in the room
Be sure the patient's chest and abdomen are exposed to observe for respiratory effort
If point of care blood gas testing is available, perform serial ABGs approximately every two minutes
If the patient does not become hemodynamically unstable or hypoxemic, continue until PaCO2 ≥ 60 mmHg and ≥ 20mmHg above baseline per hospital policy
If point of care blood gas testing is not available, send an ABG after approximately every 15 minutes of apnea
When determining brain death, ancillary tests are indicated when . . . (Select all that apply.)
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A patient has injuries to the head and neck that preclude evaluation of all cranial nerve reflexes
A patient has an underlying medical condition that precludes safely completing apnea testing
A patient is unable to tolerate the apnea test without risk of cardiac arrest, due to hemodynamic instability
It is the preference of the physician performing the brain death evaluation
The physician wants to confirm that the results of the apnea test and bedside exam are accurate
When informing the family that the brain death evaluation has confirmed death, you should: (Select all that apply.)
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Provide a detailed explanation of all aspects of the exam findings using accurate medical terminology
Provide the actual time of death early in the conversation
Use simple, direct language, free of unnecessary detail
Use the word "dead" or "died," rather than "brain dead"
Demonstrate sensitivity by using euphemisms for death such as "passed away," "gone," or "expired"
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