Risk Factors for Post-Traumatic Stress Disorder Symptoms in Surrogate Decision-Makers of Patients with Chronic Critical Illness

Wendlandt, Blair; Ceppe, Agathe; Choudhury, Summer; Nelson, Judith E.; Cox, Christopher E.; Hanson, Laura C.; Danis, Marion; Tulsky, James A.; Carson, Shannon S.

doi:10.1513/annalsats.201806-420oc

Cited by 29 publications

(25 citation statements)

References 28 publications

(24 reference statements)

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“…31 The authors are not aware of additional similar studies exploring the general public's knowledge and preparedness for the SDM role. However, observational studies from the USA suggest being an SDM is associated with elevated levels of anxiety and depression in some people 32 and that a person's confidence to be an SDM varies substantially, with people who have previous SDM experience or greater communication with the patient's doctor demonstrating increased confidence levels compared with those who do not. 33 Yet it may not be common for health professionals to provide guidance to SDMs in practice, such as counselling an SDM on how to perform the role or the principles underpinning it, suggesting a need to understand the specific challenges SDMs experience and their preferences for obtaining support in the role.…”

Section: What Is Their Significance?mentioning

confidence: 99%

Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

Sellars

Tran

Nolte

et al. 2021

BMJ Support Palliat Care

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ObjectiveTo describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.MethodsThis is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.ResultsOf 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.ConclusionsThe Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.

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Section: What Is Their Significance?mentioning

confidence: 99%

Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

Sellars

Tran

Nolte

et al. 2021

BMJ Support Palliat Care

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“…These items were targeted because they represent patientcentered items that are considered by the instrument developers as 'actionable' components of clinician communication, or practices that could be improved if deficits are identified [21]. The individual patient-centered items are shown in Table 3 [25]) on or near day 10 of mechanical ventilation are risk factors for surrogate PTSD symptoms [26], we also adjusted our analyses for these factors. Additional covariates in the analyses in the present study included site and intervention group from the original clinical trial (https:// clinicaltrials.gov identifier NCT01230099) [13], duration of patient mechanical ventilation, and patient mortality at 90 days.…”

Section: Analysesmentioning

confidence: 99%

“…Additional covariates in the analyses in the present study included site and intervention group from the original clinical trial (https:// clinicaltrials.gov identifier NCT01230099) [13], duration of patient mechanical ventilation, and patient mortality at 90 days. Patient and surrogate demographics, patient co-morbidities and severity of illness were not associated with surrogate PTSD symptoms in previous analyses [26], and thus were not included in modeling.…”

Section: Analysesmentioning

confidence: 99%

Modifiable elements of ICU supportive care and communication are associated with surrogates’ PTSD symptoms

et al. 2019

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Purpose: To identify specific components of ICU clinician supportive care and communication that are associated with increased post-traumatic stress disorder (PTSD) symptoms for surrogate decision makers of patients with chronic critical illness (CCI). Methods: We conducted a secondary analysis of data from a randomized controlled trial of palliative care-led meetings to provide information and support for CCI surrogates. The primary outcome for this secondary analysis was PTSD symptoms at 90 days, measured by the Impact of Event Scale-Revised (IES-R). Caregiver perceptions of clinician support and communication were assessed using a version of the After-Death Bereaved Family Member Interview (ADBFMI)

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“…For example, a secondary analysis of more than 300 surrogate decision-makers found only high baseline anxiety and depression, and patient unresponsiveness on day 10 of mechanical ventilation were associated with post-traumatic stress symptoms in surrogate decision-makers 3 months later. 45 Day 10 of mechanical ventilation is a common clinical crossroad. One hypothesis is that surrogate decision-makers of unresponsive patients on day 10 were asked to choose between a tracheostomy and withdrawing ventilator support, and developed post-traumatic stress symptoms as a result of this decision.…”

Section: Challenges In the Design And Interpretation Of Icu Communicamentioning

confidence: 99%

Aligning use of intensive care with patient values in the USA: past, present, and future

Turnbull

Bosslet

Kross

2019

The Lancet Respiratory Medicine

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For more than three decades, both medical professionals and the public have worried that many patients receive non-beneficial care in US intensive care units during their final months of life. Some of these patients wish to avoid severe cognitive and physical impairments, and protracted deaths in the hospital setting. Recognising when intensive care will not restore a person’s health, and helping patients and families embrace goals related to symptom relief, interpersonal connection, or spiritual fulfilment are central challenges of critical care practice in the USA. We review trials from the past decade of interventions designed to address these challenges, and present reasons why evaluating, comparing, and implementing these interventions have been difficult. Careful scrutiny of the design and interpretation of past trials can show why improving goal concordant care has been so elusive, and suggest new directions for the next generation of research.

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Risk Factors for Post-Traumatic Stress Disorder Symptoms in Surrogate Decision-Makers of Patients with Chronic Critical Illness

Abstract: Among surrogate decision-makers for chronically critically ill patients, high anxiety and depression scores and patient unresponsiveness on or near Day 10 of mechanical ventilation are risk factors for PTSD symptoms at 90 days.

Cited by 29 publications

References 28 publications

Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey

Modifiable elements of ICU supportive care and communication are associated with surrogates’ PTSD symptoms

Aligning use of intensive care with patient values in the USA: past, present, and future

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