Jared Chiarchiaro|Praewpannarai Buddadhumaruk|Robert M. Arnold|Douglas B. White
Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients
Pulmonary and Allergy Associates|Institute of Medical Ethics|Center for Practical Bioethics|University of Pittsburgh
rationale although numerous studies documented family members intensive care units struggle endoflife decisions incapacitated patients little information whether prior advance care planning lessens burden decision makingobjectives sought measure decisional conflict surrogates critically ill patients examine whether prior advance care planning associated less decisional conflictmethods performed secondary data analysis multicenter prospective cohort study done five us academic medical centers included 471 surrogates 257 patients acute respiratory distress syndromethe main outcome surrogates burden decision making measured using decisional conflict scalesurrogates completed questionnaire item addressing whether prior advance care planning conversations loved oneswe used multilevel linear regression modeling measure association decisional conflict advance care planningmeasurements main results moderate high levels decisional conflict decisional conflict scale score 25 present 48 surrogatesafter adjusting potential confounders surrogates engaged prior advance care planning conversations significantly lower levels decisional conflict mean score 33 points lower decisional conflict scale 95 confidence interval 264 202 p 003conclusions nearly half surrogates critically ill patients moderate high levels decisional conflictprior advance care planning associated less decisional conflictthese results suggest scope benefit advance care planning may extend beyond respecting patients wishes also ameliorating burden patients loved ones act surrogates