+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients

Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients

Annals of the American Thoracic Society 12(10): 1528-1533

Although numerous studies have documented that family members in intensive care units struggle with end-of-life decisions for incapacitated patients, there is little information about whether prior advance care planning lessens the burden of decision making. We sought to measure decisional conflict in surrogates of critically ill patients and to examine whether prior advance care planning is associated with less decisional conflict. We performed a secondary data analysis of a multicenter, prospective cohort study done at five U.S. academic medical centers that included 471 surrogates of 257 patients with acute respiratory distress syndrome. The main outcome was surrogates' burden of decision making as measured using the Decisional Conflict Scale. Surrogates completed a questionnaire item addressing whether they had had any prior advance care planning conversations with their loved ones. We used multilevel linear regression modeling to measure the association between decisional conflict and advance care planning. Moderate or high levels of decisional conflict (Decisional Conflict Scale score≥25) were present in 48% of surrogates. After adjusting for potential confounders, surrogates who had engaged in prior advance care planning conversations had significantly lower levels of decisional conflict than those who had not (mean score 3.3 points lower on the Decisional Conflict Scale; 95% confidence interval, -6.4 to -0.2; P=0.03). Nearly half of surrogates for critically ill patients have moderate or high levels of decisional conflict. Prior advance care planning was associated with less decisional conflict. These results suggest that the scope of the benefit of advance care planning may extend beyond respecting patients' wishes to also ameliorating the burden on patients' loved ones who act as surrogates.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 058627031

Download citation: RISBibTeXText

PMID: 26240996

DOI: 10.1513/annalsats.201504-253oc

Related references

High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study. Chronic Illness 12(3): 227-235, 2016

Advance care planning beyond advance directives: perspectives from patients and surrogates. Journal of Pain and Symptom Management 46(3): 355-365, 2013

Validation of the Decisional Conflict Scale for Evaluating Advance Care Decision Conflict in Community-dwelling Older Adults. Asian Nursing Research 11(4): 297-303, 2017

LVAD patients' and surrogates' perspectives on SPIRIT-HF: An advance care planning discussion. Heart and Lung 45(4): 305-310, 2017

Engagement in Advance Care Planning and Surrogates' Knowledge of Patients' Treatment Goals. Journal of the American Geriatrics Society 65(8): 1712-1718, 2017

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates. Journal of Palliative Medicine 19(2): 134-142, 2016

A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates. Heart and Lung 45(3): 186-192, 2017

Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates. American Journal of Kidney Diseases 66(5): 813-822, 2015

Health System Advance Care Planning Culture Change for High-Risk Patients: The Promise and Challenges of Engaging Providers, Patients, and Families in Systematic Advance Care Planning. Journal of Palliative Medicine 20(4): 388-394, 2017

Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention. Bmj Open 7(2): E013415, 2017

Advance care planning for decisional incapacity: keep it simple--find your patient's goal threshold in under 5 minutes. Medscape Journal of Medicine 10(10): 240, 2008

Patient-Surrogate Agreement in Advance Care Planning: Who Are the Surrogates and Are They Making the Right Decisions?. Annals of the Academy of Medicine Singapore 47(10): 431-434, 2018

Preparing Surrogates for Complex Decision Making: The Often Neglected Piece of the Advance Care Planning Equation. JAMA Internal Medicine 179(2): 268-269, 2019

Decisional conflict in end-of-life cancer treatment among family surrogates: A cross-sectional survey. Nursing and Health Sciences 20(4): 472-478, 2018

The Efficacy of Family Centered (Face) Advance Care Planning on Congruence in End-of-Life Treatment Preferences Between Adults Living with Hiv and their Surrogates Over Time. Journal of Pain and Symptom Management 56(6): e79-e80, 2018