The following is a summary of “Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates,” published in the November 2024 issue of Critical Care by DeForge et al.
Surrogates of patients with critical illness in the intensive care unit (ICU) often make decisions regarding life-sustaining treatments, but decisional conflict in this context remains underexplored.
Researchers conducted a retrospective study to compare the experiences of ICU surrogates based on the reported decisional conflict regarding treatment decisions following a patient’s cardiac arrest before death.
They used convergent mixed methods to analyze bereaved surrogates from a northeastern US academic medical center. Surrogates completed surveys, including the low-literacy Decisional Conflict Scale (moderate-to-high cut point >25), and participated in interviews about 1 month after the patient’s death. Directed and conventional content analysis was applied to the interview data. Surrogates were stratified by the median total survey score, and interview findings were compared based on decisional conflict levels.
The results showed that of 16 surrogates, 7 reported decisional conflict (median survey score, 0; range, 0-25). Approximately two-thirds chose to withdraw treatments. Interviews revealed 3 themes: 2 on decision-making (“the ultimate act”; “the legacy of clinician communication”) and 1 on bereavement (“I wish there was a handbook”). Surrogates with decisional conflict included those who initially pursued but later withdrew treatments following a patient’s in-hospital cardiac arrest. They described suboptimal support, poor medical understanding, and unclear treatment preferences as contributing factors.
Investigators concluded that bereaved ICU surrogates’ experiences were shaped by low overall survey scores, possibly due to retrospective measurement, and emphasized the need for novel approaches to support surrogates, particularly those underrepresented who pursued treatment.
Source: aacnjournals.org/ajcconline/article/33/6/433/32574/Medical-Decision-Making-and-Bereavement
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