Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis.
Karen O Moss, Sara L Douglas, Eric Baum and 1 others
PMID 31154339WHAT IT FOUND
Family surrogates of chronically critically ill adults valued clear, consistent communication and being included in decisions.
They also carried stress, regret and sleep loss, and relied on family, faith and trusted staff for support.
Key findings
01Family surrogates appreciated being involved in decisions, being explained to, and trusted nurses for helpful information.
02Surrogates often sought input from other family members or friends and relied on previous conversations with the patient about their wishes.
03Surrogates described decision making as frustrating and stressful, and often reported decisional regret despite support systems.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 7 family surrogates, selected conveniently from a larger study, so the themes may not represent all surrogates. It did not include surrogates whose loved one died in the ICU after decisions to limit life-sustaining interventions, so it misses that group. Interviews took place in the healthcare setting, which may have limited how freely surrogates spoke about providers. The findings are qualitative experiences; they do not test whether nurse-led communication or family meetings improve outcomes. The patient sample was 57% male and 57% Caucasian, and 71.4% did not have a Do Not Attempt Resuscitation order, so the findings may not reflect all ICU surrogate decisions.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not treat this as evidence that nurse-led communication changes patient or family outcomes. Seven surrogates were interviewed, and the study only described their experiences and themes.