Elizabeth J Lilley1, Megan A Morris2, Nicholas Sadovnikoff3, Jamahal M Luxford4, Navin R Changoor5, Anna Bystricky6, Angela M Bader7, Zara Cooper8. 1. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: elilley@partners.org. 2. Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. 4. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA; Department of Anaesthesia, St Vincent's Hospital, Melbourne, Australia. 5. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Howard University College of Medicine, Washington, DC. 6. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 7. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA. 8. The Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Abstract
BACKGROUND: Impaired capacity of patients necessitates the use of surrogates to make decisions on behalf of patients. Little is known about surrogate decision-making in the surgical intensive care unit, where the decline to critical illness is often unexpected. We sought to explore surrogate experiences with decision-making in the surgical intensive care unit. METHODS: This qualitative study was performed at 2 surgical intensive care units at a single, tertiary, academic hospital Surrogate decision-makers who had made a major medical decision for a patient in the surgical intensive care unit were identified and enrolled prospectively. Semistructured telephone interviews following an interview guide were conducted within 90 days after hospitalization until thematic saturation. Recordings were transcribed, coded inductively, and analyzed utilizing an interpretive phenomenologic approach. RESULTS: A major theme that emerged from interviews (N = 19) centered on how participants perceived the surrogate role, which is best characterized by 2 archetypes: (1) Preferences Advocates, who focused on patients' values; and (2) Clinical Facilitators, who focused on patients' medical conditions. The primary archetype of each surrogate influenced how they defined their role and approached decisions. Preferences Advocates framed decisions in the context of patients' values, whereas Clinical Facilitators emphasized the importance of clinical information. CONCLUSION: The experiences of surrogates in the surgical intensive care unit are related to their understanding of what it means to be a surrogate and how they fulfill this role. Future work is needed to identify and manage the informational needs of surrogate decision-makers.
BACKGROUND: Impaired capacity of patients necessitates the use of surrogates to make decisions on behalf of patients. Little is known about surrogate decision-making in the surgical intensive care unit, where the decline to critical illness is often unexpected. We sought to explore surrogate experiences with decision-making in the surgical intensive care unit. METHODS: This qualitative study was performed at 2 surgical intensive care units at a single, tertiary, academic hospital Surrogate decision-makers who had made a major medical decision for a patient in the surgical intensive care unit were identified and enrolled prospectively. Semistructured telephone interviews following an interview guide were conducted within 90 days after hospitalization until thematic saturation. Recordings were transcribed, coded inductively, and analyzed utilizing an interpretive phenomenologic approach. RESULTS: A major theme that emerged from interviews (N = 19) centered on how participants perceived the surrogate role, which is best characterized by 2 archetypes: (1) Preferences Advocates, who focused on patients' values; and (2) Clinical Facilitators, who focused on patients' medical conditions. The primary archetype of each surrogate influenced how they defined their role and approached decisions. Preferences Advocates framed decisions in the context of patients' values, whereas Clinical Facilitators emphasized the importance of clinical information. CONCLUSION: The experiences of surrogates in the surgical intensive care unit are related to their understanding of what it means to be a surrogate and how they fulfill this role. Future work is needed to identify and manage the informational needs of surrogate decision-makers.
Authors: Thaddeus M Pope; Joshua Bennett; Shannon S Carson; Lynette Cederquist; Andrew B Cohen; Erin S DeMartino; David M Godfrey; Paula Goodman-Crews; Marshall B Kapp; Bernard Lo; David C Magnus; Lynn F Reinke; Jamie L Shirley; Mark D Siegel; Renee D Stapleton; Rebecca L Sudore; Anita J Tarzian; J Daryl Thornton; Mark R Wicclair; Eric W Widera; Douglas B White Journal: Am J Respir Crit Care Med Date: 2020-05-15 Impact factor: 21.405