Psychological Attachment Orientations of Surrogate Decision-Makers and Goals-of-Care Decisions for Brain Injury Patients in ICUs

Abstract

Supplemental Digital Content is available in the text.

End-of-Life Care Decision-Making in Stroke

“…While most surrogates prioritized respecting patients' perceived wishes and reducing suffering, surrogates may belong to different subgroups characterized by varying other top concerns: patient age, family agreement, prognostication, and cost of long-term care ( 75 ). Both non-white race and high religiosity may predict a surrogate choosing life-sustaining therapy over CMO ( 76 ). However, such a decision is still fraught with uncertainty; for example, respondents in the aforementioned study of US residents who were most concerned about cost of care were still more likely to choose tracheostomy and PEG placement over CMO compared with those less concerned ( 77 ).…”

Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients

“…Figure 2 outlines details of study recruitment. During Phase 1, we enrolled 42 of 110 eligible family members (38.2%) at 6 months following their participation in our previous study on attachment orientation ( 30 ). During Phase 2, we enrolled 171 of 302 additional eligible family members (56.6%) near time of ICU discharge or death, with 120 of 171 (70.2%) retained at 6-month follow-up.…”

“… Study enrollment. Enrollment phase 1 was follow-up from a previous study with the exact same inclusion criteria and covariates as this study, as well as the same timing of initial participant enrollment relative to patient ICU discharge or death ( 30 ). IES-R = Impact of Events Scale—Revised, RQ = Relationship Questionnaire.…”

“…However, the overall proportion of families in our study with post-ICU PTSD symptoms was similar to those of prior general ICU studies ( 57 – 59 ), and we adequately powered our study to detect a meaningful difference in PTSD symptoms between our anxious versus nonanxious groups. Our study enrollment was conducted in two distinct phases, although both phases were prospective, and the first phase simply leveraged participants we had recruited for a prior study which already had the same exact inclusion criteria and initial enrollment window in the ICU ( 30 ). Biases associated with subject nonenrollment and loss to follow-up are always a concern ( 60 ).…”

“…We recruited participants for this study in two separate phases. For Phase 1, from November 2017 to August 2018, we recruited participants from a consecutive sample of family members who had just recently participated in an in-hospital, cross-sectional study of the relationship between attachment orientation and goals-of-care decision making ( 30 ). This previous study had the exact same inclusion criteria and covariates as this study, and the timing of enrolling participants relative to patient ICU discharge or death was the same as this study.…”