Alyssa Majesko|Seung Ho Hong|Lisa A. Weissfeld|Douglas B. White
Identifying family members who may struggle in the role of surrogate decision maker*
although acting surrogate decision maker highly distressing family members intensive care unit patients little known whether modifiable risk factors occurrence difficulties objectives identify 1 factors associated lower levels confidence among family members function surrogates 2 whether quality clinicianfamily communication associated timing decisions forego life support methods conducted prospective study 230 surrogate decision makers incapacitated mechanically ventilated patients high risk death four intensive care units university california san francisco medical center 2006 2007 surrogates completed questionnaire addressing perceived ability act surrogate quality communication physicians used clustered multivariate logistic regression identify predictors low levels perceived ability act surrogate cox proportional hazard model determine whether quality communication associated timing decisions withdraw life support results substantial variability family members confidence act surrogate decision makers 27 rating perceived ability 7 lower 10point scale independent predictors lower role confidence lack prior experience surrogate odds ratio 22 95 confidence interval 104446 p 04 prior discussions patient treatment preferences odds ratio 37 95 confidence interval 179776 p 001 poor quality communication icu physician odds ratio 12 95 confidence interval 109135 p 001 higher quality physicianfamily communication associated significantly shorter duration lifesustaining treatment among patients died 011 p 001 conclusions family members without prior experience surrogate engaged advanced discussions patient treatment preferences higher risk report less confidence carrying surrogate role betterquality clinicianfamily communication associated confidence among family members act surrogates shorter duration use life support among patients died