The Influence of Surrogate Decision Makers on Clinical Decision Making for Critically III Adults

Raj D. Shah, Kenneth A. Rasinski, George Caleb Alexander

Research output: Contribution to journalArticle

Abstract

Purpose: Intensive care unit patients rarely have decisional capacity and often surrogates make clinical decisions on their behalf. Little is known about how surrogate characteristics may influence end-of-life decision making for these patients. This study sought to determine how surrogate characteristics impact physicians' approach to end-of-life decision making. Methods: From March 2011 to August 2011, a survey was fielded to 1000 randomly sampled critical care physicians using a modified Dillman approach. The survey included a hypothetical vignette to examine how physicians' approach varied based on patient age, patient-surrogate relationship, surrogate-staff relationship, basis for surrogate's stated preferences, and surrogate's understanding of patient's condition. Outcomes included physicians' beliefs regarding (1) appropriateness of cardiopulmonary resuscitation (CPR); (2) appropriate locus of decision making for the patient; (3) degree to which a physician would try to influence a surrogate if disagreement was present; and (4) physician strategies to discussing end-of-life with surrogates. Results: Of 922 eligible physicians, 608 (66%) participated. Across all vignettes, CPR was felt to be less appropriate and surrogates less likely to be given priority with an older rather than younger patient (15% vs 63% and 50% vs 65%, both P values

Original languageEnglish (US)
Pages (from-to)278-285
Number of pages8
JournalJournal of Intensive Care Medicine
Volume30
Issue number5
DOIs
StatePublished - Jul 10 2015

Fingerprint

Physicians
Decision Making
Cardiopulmonary Resuscitation
Critical Care
Clinical Decision-Making
Intensive Care Units
Surveys and Questionnaires

Keywords

  • communication barriers
  • conflict
  • intensive care
  • medical ethics
  • patient-physician relationship
  • withholding treatment

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The Influence of Surrogate Decision Makers on Clinical Decision Making for Critically III Adults. / Shah, Raj D.; Rasinski, Kenneth A.; Alexander, George Caleb.

In: Journal of Intensive Care Medicine, Vol. 30, No. 5, 10.07.2015, p. 278-285.

Research output: Contribution to journalArticle

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