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Palliative Care and End of Life Issues |

Dimensions and Mediators of Surrogate Trust in the Intensive Care Unit

Paul Hutchison, MD; Katie McLaughlin; Thomas Corbridge, MD; Megan Crowley-Matoka, PhD
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Northwestern University, Chicago, IL


Chest. 2013;144(4_MeetingAbstracts):752A. doi:10.1378/chest.1698535
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Abstract

SESSION TITLE: End of Life Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Surrogate trust of intensive care unit (ICU) clinicians is an important factor in avoiding conflict in end-of-life decision-making. Our aim is to use qualitative methods to identify domains of trust in the ICU and factors that promote its formation.

METHODS: We are conducting in-depth, semi-structured interviews with surrogate decision-makers in a closed-model medical ICU. Questions target surrogates’ general ICU experience, staff and institutional qualities integral to trust, and components of trust unique to the ICU. Interviews are audio recorded and then transcribed. Transcripts have been analyzed using a modified grounded-theory approach.

RESULTS: Preliminary data demonstrate surrogates’ strong emphasis on nursing care when describing their experience in the ICU. The constant activity and focus of nurses in patient rooms strengthens trust and reassures surrogates that their loved ones will receive good care even at times when they are not present. Surrogates frequently mention coordinated and thorough nursing care at the time of ICU admission as a relevant factor in establishing trust. In contrast, many surrogates admit to blind trust in the ICU physicians, which may be affected by institutional reputation. When describing physician activities that increase trust, surrogates commonly cite honesty and bluntness when delivering bad news. They also value physicians’ ability to communicate with lay language and to exhibit personal, humanistic qualities when interacting with surrogates.

CONCLUSIONS: Our results support the following conclusions regarding surrogate trust in the ICU: 1) Strong nursing care, especially upon ICU admission, is essential to establishing trust and to maintaining a working relationship with surrogates; 2) Physician trust is most closely tied to the style and content of their communication with surrogates; 3) Interventions aimed at increasing trust should be role specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust.

CLINICAL IMPLICATIONS: Physicians and nurses have an opportunity to augment trust through subtle behavior changes that can be integrated into their current practice. Improved trust may decrease conflict and contribute to more constructive goals of care discussions.

DISCLOSURE: The following authors have nothing to disclose: Paul Hutchison, Katie McLaughlin, Thomas Corbridge, Megan Crowley-Matoka

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