Ellen Iverson1, Aaron Celious2, Carie R Kennedy3, Erica Shehane2, Alexander Eastman4, Victoria Warren4, Bradley D Freeman3. 1. Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address: elleni@chla.usc.edu. 2. Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA. 3. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 4. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Abstract
OBJECTIVES: This study explores surrogate decision-makers' (SDMs) challenges making decisions related to the care of patients in critical care, to (1) characterise the SDM stress, (2) identify personal, social, care-related factors influencing stress and (3) consider implications of findings to improving critical care practice. METHODOLOGY: Semi-structured interviews were conducted with SDMs of critically ill patients receiving care in two tertiary care institutions. Transcripts were analysed using a grounded theory approach. Domains explored were: stress characteristics, stress mitigators, coping strategies, social networks, SDM decision-making role, decision-making concordance, knowledge of patient's preferences, experience with provider team, SDM-provider communication, patient outcome certainty. MAIN OUTCOMES: We interviewed 34 SDMs. Most were female and described long-term relationships with patients. SDMs described the strain of uncertain outcomes and decision-making without clear, consistent information from providers. Decision-making anxiety was buffered by SDMs' active engagement of social networks, faith and access to clear communication from providers. CONCLUSION: Stress is a very real factor influencing SDMs confidence and comfort making decisions. These findings suggest that stress can be minimised by improving communication between SDMs and medical providers. Nurses' central role in the ICU makes them uniquely poised to spearhead interventions to improve provider-SDM communication and reduce SDM decision-making anxiety.
OBJECTIVES: This study explores surrogate decision-makers' (SDMs) challenges making decisions related to the care of patients in critical care, to (1) characterise the SDM stress, (2) identify personal, social, care-related factors influencing stress and (3) consider implications of findings to improving critical care practice. METHODOLOGY: Semi-structured interviews were conducted with SDMs of critically illpatients receiving care in two tertiary care institutions. Transcripts were analysed using a grounded theory approach. Domains explored were: stress characteristics, stress mitigators, coping strategies, social networks, SDM decision-making role, decision-making concordance, knowledge of patient's preferences, experience with provider team, SDM-provider communication, patient outcome certainty. MAIN OUTCOMES: We interviewed 34 SDMs. Most were female and described long-term relationships with patients. SDMs described the strain of uncertain outcomes and decision-making without clear, consistent information from providers. Decision-making anxiety was buffered by SDMs' active engagement of social networks, faith and access to clear communication from providers. CONCLUSION: Stress is a very real factor influencing SDMs confidence and comfort making decisions. These findings suggest that stress can be minimised by improving communication between SDMs and medical providers. Nurses' central role in the ICU makes them uniquely poised to spearhead interventions to improve provider-SDM communication and reduce SDM decision-making anxiety.
Authors: John M Luce; Deborah J Cook; Thomas R Martin; Derek C Angus; Homer A Boushey; J Randall Curtis; John E Heffner; Paul N Lanken; Mitchell M Levy; Paula Y Polite; Graeme M Rocker; Robert D Truog Journal: Am J Respir Crit Care Med Date: 2004-12-15 Impact factor: 21.405
Authors: Judy E Davidson; Karen Powers; Kamyar M Hedayat; Mark Tieszen; Alexander A Kon; Eric Shepard; Vicki Spuhler; I David Todres; Mitchell Levy; Juliana Barr; Raj Ghandi; Gregory Hirsch; Deborah Armstrong Journal: Crit Care Med Date: 2007-02 Impact factor: 7.598
Authors: Latifat Apatira; Elizabeth A Boyd; Grace Malvar; Leah R Evans; John M Luce; Bernard Lo; Douglas B White Journal: Ann Intern Med Date: 2008-12-16 Impact factor: 25.391
Authors: Christina Jones; Paul Skirrow; Richard D Griffiths; Gerrald Humphris; Sarah Ingleby; Jane Eddleston; Carl Waldmann; Melanie Gager Journal: Intensive Care Med Date: 2004-02-04 Impact factor: 17.440
Authors: Leah R Evans; Elizabeth A Boyd; Grace Malvar; Latifat Apatira; John M Luce; Bernard Lo; Douglas B White Journal: Am J Respir Crit Care Med Date: 2008-10-17 Impact factor: 21.405
Authors: Elizabeth K Vig; Helene Starks; Janelle S Taylor; Elizabeth K Hopley; Kelly Fryer-Edwards Journal: J Gen Intern Med Date: 2007-07-07 Impact factor: 5.128
Authors: Michael J Green; Lauren J Van Scoy; Andrew J Foy; Renee R Stewart; Ramya Sampath; Jane R Schubart; Erik B Lehman; Anne E F Dimmock; Ashley M Bucher; Lisa S Lehmann; Alyssa F Harlow; Chengwu Yang; Benjamin H Levi Journal: Am J Hosp Palliat Care Date: 2017-11-29 Impact factor: 2.500
Authors: Kathleen J Ramos; Lois Downey; Elizabeth L Nielsen; Patsy D Treece; Sarah E Shannon; J Randall Curtis; Ruth A Engelberg Journal: J Palliat Med Date: 2015-12-18 Impact factor: 2.947
Authors: Grant A Pignatiello; Barbara Daly; Heath Demaree; Shirley Moore; Ronald L Hickman Journal: Appl Nurs Res Date: 2019-09-03 Impact factor: 2.257
Authors: Paul J Hutchison; Katie McLaughlin; Tom Corbridge; Kelly N Michelson; Linda Emanuel; Peter H S Sporn; Megan Crowley-Matoka Journal: Crit Care Med Date: 2016-12 Impact factor: 7.598
Authors: Michelle Olding; Sarah E McMillan; Scott Reeves; Madeline H Schmitt; Kathleen Puntillo; Simon Kitto Journal: Health Expect Date: 2015-09-07 Impact factor: 3.377