Clinical Research Directory

Inclusion criteria for surrogates and patients: * surrogate is age 18 years or older, no upper age limit; * documented surrogate decision-maker (official health care proxy, or legal next of kin) of a critically ill severe acute brain injury (SABI) patient ≥ 3 days after admission; * patient is age 18 years or older, no upper age limit; * patient has SABI; defined as either traumatic brain injury, spontaneous primary intracerebral hemorrhage (not due to tumor or vascular malformation), or hemispheric acute ischemic stroke; * patient is"critically ill" defined as either intubated on a mechanical ventilator, or unable to swallow without a feeding tube (even if not intubated/ventilated); * patient is judged by the attending physician to have ≥40% risk of death or long-term functional impairment, elicited by asking the attending physician, "does this patient have at least a 40% chance of in-hospital mortality or long-term functional impairment?", defined as needing assistance with at least 1 activity of daily living (ADL). * patient has undergone initial stabilization but remains critically ill; * surrogate will participate in clinician-family goals of care meeting, either in person or via video- or telephone-conference. * surrogate must be English speaking and literate Exclusion Criteria for surrogates and patients: * devastating patients with severe SABI who die early (within the first 3 days after admission); * surrogate decision-maker is non-English speaking; * surrogate decision-maker is illiterate. Inclusion criteria for clinicians: * clinical treating attending, or physician trainee (fellow, resident), or licensed affiliated practitioner who will lead the clinician-family meeting when goals-of-care are discussed; * clinician may decline participation in the outcome measures but cannot restrict the surrogate decision-maker in study participation. Exclusion criteria for clinicians: \- unwillingness to comply with study protocol.