1. The Voice of Surrogate Decision-Makers. Family Responses to Prognostic Information in Chronic Critical Illness
- Author
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Christopher E. Cox, Douglas B. White, Kristine L. Keller, Stefanie P. Weiss, Marion Danis, James A. Tulsky, Shannon S. Carson, Judith E Nelson, Laura C. Hanson, and Emily Chai
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Palliative care ,Critical Care ,Critical Illness ,medicine.medical_treatment ,Decision Making ,Critical Care and Intensive Care Medicine ,Grounded theory ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Professional-Family Relations ,law ,Intensive care ,medicine ,Humans ,Family ,030212 general & internal medicine ,Intensive care medicine ,Health communication ,Mechanical ventilation ,Critically ill ,business.industry ,Palliative Care ,Middle Aged ,Prognosis ,Respiration, Artificial ,030228 respiratory system ,Chronic Disease ,Critical illness ,Female ,business - Abstract
Information from clinicians about the expected course of the patient's illness is relevant and important for decision-making by surrogates for chronically critically ill patients on mechanical ventilation.To observe how surrogates of chronically critically ill patients respond to information about prognosis from palliative care clinicians.This was a qualitative analysis of a consecutive sample of audio-recorded meetings from a larger, multisite, randomized trial of structured informational and supportive meetings led by a palliative care physician and nurse practitioner for surrogates of patients in medical intensive care units with chronic critical illness (i.e., adults mechanically ventilated for ≥7 days and expected to remain ventilated and survive for ≥72 h).A total of 66 audio-recorded meetings involving 51 intervention group surrogates for 43 patients were analyzed using grounded theory. Six main categories of surrogate responses to prognostic information were identified: (1) receptivity, (2) deflection/rejection, (3) emotion, (4) characterization of patient, (5) consideration of surrogate role, and (6) mobilization of support. Surrogates responded in multiple and even antithetical ways, within and across meetings.Prognostic disclosure by skilled clinician communicators evokes a repertoire of responses from surrogates for the chronically critically ill. Recognition of these response patterns may help all clinicians better communicate their support to patients and families facing chronic critical illness and inform interventions to support surrogate decision-makers in intensive care units. Clinical trial registered with www.clinicaltrials.gov (NCT 01230099).
- Published
- 2017