Medical Decision-Making and Bereavement Experiences After Cardiac Arrest: Qualitative Insights From Surrogates.
Christine E DeForge, Arlene Smaldone, Sachin Agarwal and 1 others
PMID 39482094WHAT IT FOUND
Bereaved ICU surrogates described heavy responsibility, unclear prognosis, and conflicting staff messages after cardiac arrest.
They wanted honest information and guidance about what happens next, including financial, physical, and role changes in the first months.
Key findings
01Surrogates described carrying the onus of responsibility even when family supported them, and some became decision makers because they were the only one available or willing.
02Surrogates who reported decisional conflict often described poorer medical understanding or unclear patient wishes; surrogates who understood treatment and long-term prognosis commonly reported no conflict.
03All surrogates described how their lives changed after the loss, including wanting guidance about next steps, financial hardship, physical symptoms, shock or unresolved questions about the arrest, and disrupted routines, work, and caregiving roles.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 16 surrogates from one urban academic hospital were studied, and most had chosen to withdraw treatment, so it may not represent surrogates who pursued unsuccessful treatments or other settings. The decisional conflict survey was completed more than 1 month after the decisions, so low scores may reflect forgetting or reduced distress rather than no conflict. The low-literacy scale was not psychometrically tested in ICU surrogates, and its wording may have been ambiguous about which decision it measured. Interviews began at least 1 month after death, which may have caused recall and self-selection bias; people who did not take part may have had different experiences. The bereavement theme was not fully saturated, and the study did not examine later regret or longer-term outcomes. The findings may not apply outside cardiac arrest, the United States, or English-speaking families.
Declared interests
The supplied text does not report author conflicts of interest. The article is tagged as research support from non-U.S. government and NIH extramural sources.
The easy way to misread this
Do not read the low survey scores as proof that surrogates had no decisional conflict. The survey was retrospective, more than 1 month after the decisions, and the interviews described uncertainty, poor understanding, and conflicting information.