The Stresses of Surrogate Decision-Making: Contributing Factors and Clinicians’ Role in Mitigation

Abstract

Background Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation. Methods An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience. Results 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision ( P = .003), Respondent Religion ( P = .015), or religious or spiritual beliefs ( P = .024), and having their own health problems (P = .008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful ( P < .001), knew the patient’s wishes ( P = .0011), specifically discussed patient wishes ( P < .001), or patient’s wishes were documented ( P < .001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P < .001), respectful ( P = .007), honest ( P < .001), and validating ( P = .001). Conclusions Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress.