"They Would Lift My Spirits": Sources of Support for Family Surrogate Decision-Makers at the End of Life.
Marlena C Fisher, Elaina Parrillo, Claire Petchler and 5 others
PMID 36907841WHAT IT FOUND
Surrogates valued advance directives and informal conversations not for their precision, but because they allowed them to feel they were honoring the patient's wishes.
Medical teams should explicitly validate that surrogates are doing a good job, as affirmation from staff and friends was a key source of support.
Key findings
01Advance directives and prior conversations helped surrogates frame decisions as carrying out patient wishes rather than making independent judgments, reducing decisional burden.
02Surrogates highly valued affirmation from medical staff and friends that they were doing a good job in their decision-making role.
03Secondary discussions with friends or family who were medical professionals or had recent loss experiences helped surrogates process and understand information from the care team.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small (13 surrogates). 9 of the 13 surrogates had received the parent study's intervention, which promoted patient-family discussion, potentially over-representing the value of those conversations. Data was collected 8 to 12 years ago, before the impact of pandemic-related visitation restrictions on family support. It is a secondary analysis with a new aim, not originally designed to explore support mechanisms in depth.
Declared interests
The authors have no conflict of interest to declare.
The easy way to misread this
Do not interpret the positive view of advance directives as evidence that they provide precise clinical guidance. The study found they helped surrogates feel ethically justified and confident, not that they answered specific treatment questions.