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Treatment decisions following severe acute brain injury need to consider patients' goals-of-care and long-term outcomes. Using family members as respondents, we aimed to assess patients' goals-of-care in the ICU and explore the impact of adaptation on survivors who did not reach the level of recovery initially considered acceptable. Prospective, observational, mixed-methods cohort study. Comprehensive stroke and level 1 trauma center in Pacific Northwest United States. Family members of patients with severe acute brain