Decision-making in the ICU: perspectives of the substitute decision-maker.

Full Abstract

OBJECTIVE:
To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making.

DESIGN:
Prospective, multicenter, cohort study.

SETTING:
Six Canadian university-affiliated ICUs.

PATIENTS AND PARTICIPANTS:
We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h.

INTERVENTION:
None.

MEASUREMENTS AND RESULTS:
A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included:
complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites.

CONCLUSIONS:
In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.

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Author information

Author/s: Heyland, Daren K (DK); Cook, Deborah J (DJ); Rocker, Graeme M (GM); Dodek, Peter M (PM); Kutsogiannis, Demetrios J (DJ); Peters, Sharon (S); Tranmer, Joan E (JE); O'Callaghan, Christopher J (CJ);

Affiliation: Department of Medicine, Angada 3, Kingston General Hospital, Ontario, Canada. dkh2(-atsign-)post.queensu.ca

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: Intensive care medicine (Intensive Care Med), published in United States. (Language: eng)

Reference: 2003-Jan; vol 29 (issue 1) : pp 75-82

Dates: Created 2003/01/15; Completed 2003/06/05; Revised 2006/11/15;

PMID: 12528026, status: MEDLINE (last retrieval date: 11/6/2008)

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