Surrogate decision makers’ perspectives on preventable breakdowns in care among critically ill patients: A qualitative study

2016 ◽  
Vol 99 (10) ◽  
pp. 1685-1693 ◽  
Author(s):  
Kimberly A. Fisher ◽  
Sumera Ahmad ◽  
Madeline Jackson ◽  
Kathleen M. Mazor
Keyword(s):  
Qualitative Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals Perspectives of surrogate decision makers for critically ill patients regarding gene variation research

2012 ◽  
Vol 15 (5) ◽  
pp. 368-373 ◽  
Author(s):  
Ellen Iverson ◽  
Aaron Celious ◽  
Carie R. Kennedy ◽  
Erica Shehane ◽  
Alexander Eastman ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Gene Variation ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

scholarly journals Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients

JAMA ◽  
2016 ◽  
Vol 315 (19) ◽  
pp. 2086 ◽  
Author(s):  
Douglas B. White ◽  
Natalie Ernecoff ◽  
Praewpannarai Buddadhumaruk ◽  
Seoyeon Hong ◽  
Lisa Weissfeld ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Structural Validity of the Hospital Anxiety and Depression Scale Among Family Members of Critically Ill Patients

2021 ◽  
Vol 30 (3) ◽  
pp. 212-220
Author(s):  
Grant A. Pignatiello ◽  
Aloen L. Townsend ◽  
Ronald L. Hickman
Keyword(s):  
Psychological Distress ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Depression Scale ◽  
Decision Makers ◽  
Anxiety And Depression ◽  
Confirmatory Factor ◽  
General Psychological Distress ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Background The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined. Objective To examine the structural validity of the HADS. Methods This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis. Results The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items. Conclusion Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients.

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