I Don’t Want to Be the One Saying ‘We Should Just Let Him Die’: Intrapersonal Tensions Experienced by Surrogate Decision Makers in the ICU
Male
Critical Care
Attitude of Health Personnel
Clinical Sciences
Decision Making
Stress
decision making
Interviews as Topic
Advance Care Planning
03 medical and health sciences
0302 clinical medicine
General & Internal Medicine
Behavioral and Social Science
end of life care
Humans
Terminally Ill
Interpersonal Relations
Third-Party Consent
intensive care
Terminal Care
ethics
United States
3. Good health
intensive care.
Intensive Care Units
Mental Health
Cross-Sectional Studies
Psychological
Female
Advance Directives
0305 other medical science
Mind and Body
Stress, Psychological
DOI:
10.1007/s11606-012-2129-y
Publication Date:
2012-07-27T16:26:15Z
AUTHORS (6)
ABSTRACT
Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention.To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies.Qualitative interview study.Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one.We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods.Surrogates experience significant emotional conflict between the desire to act in accordance with their loved one's values and 1) not wanting to feel responsible for a loved one's death, 2) a desire to pursue any chance of recovery, and 3) the need to preserve family well-being. Associated coping strategies included 1) recalling previous discussions with a loved one, 2) sharing decisions with family members, 3) delaying or deferring decision making, 4) spiritual/religious practices, and 5) story-telling.Surrogates' struggle to reconcile personal and family emotional needs with their loved ones' wishes, and utilize common coping strategies to combat intrapersonal tensions. These data suggest reasons surrogates may struggle to follow a strict substituted judgment standard. They also suggest ways clinicians may improve decision making, including attending to surrogates' emotions, facilitating family decision making, and eliciting potential emotional conflicts and spiritual needs.
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