Decision‐making among the substitute decision makers in intensive care units: An investigation of decision control preferences and decisional conflicts

2020 ◽  
Vol 76 (9) ◽  
pp. 2323-2335
Author(s):  
Feixia Wu ◽  
Yiyu Zhuang ◽  
Xiangping Chen ◽  
Huan Wen ◽  
Wenwen Tao ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Decision Makers ◽  
Decision Control ◽  
Substitute Decision Makers

Role Incongruence and Psychological Stress Symptoms in Substitute Decision Makers of Intensive Care Patients

2020 ◽  
Vol 29 (4) ◽  
pp. 301-310
Author(s):  
Orla M. Smith ◽  
Kelly Metcalfe ◽  
Martine Puts ◽  
Ellen McDonald ◽  
Shivon Sue-Chee ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Psychological Distress ◽  
Posttraumatic Stress ◽  
Scale Score ◽  
Odds Ratio ◽  
Decision Makers ◽  
Intensive Care Patients ◽  
Stress Symptoms ◽  
Substitute Decision Makers

Background Most intensive care patients require substitute decision makers (SDMs) to make decisions. The SDMs may prefer an active, shared, or passive decision-making role. Role incongruence is when preferred and actual roles differ. Objective To evaluate the impact of decision-making role preferences and role incongruence on psychological distress symptoms in SDMs. Methods A multicenter, interviewer-administered survey was conducted among SDMs of critically ill adults. The Control Preferences Scale was used to evaluate role preferences. Psychological distress was defined as anxiety, depression, or posttraumatic stress symptoms with predefined cut points on the Hospital Anxiety and Depression Scale (score > 10 on the anxiety or the depression subscale) and Impact of Events Scale (score > 30). Results One hundred eighty SDMs were recruited; 64% responded. Most were white (71%) and female (65%); 46% were spouses. Role preferences varied: active, 24%; shared, 44%; and passive, 31%. Almost half (49%) reported incongruence. Symptom prevalence was 50% for posttraumatic stress, 32% for anxiety, and 16% for depression. Most (56%) reported some psychological distress. In multivariable logistic regression, the composite outcome of psychological distress was independently associated with patient death (odds ratio, 2.95; 95% CI, 1.08-8.02; P = .03), female sex of SDM (odds ratio, 2.96; 95% CI, 1.49-5.89; P = .002), and incongruence (odds ratio, 3.26; 95% CI, 1.67-6.36; P < .001). Conclusions Adverse psychological symptoms are prevalent in SDMs of critically ill patients and are related to role incongruence.

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