Abstract 136: Family Member Perceptions of Decision-Making for Comatose Survivors of Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Bonnie Siry ◽  
Jennifer A Reich ◽  
Benjamin S Abella ◽  
Stacie L Daugherty ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Family Member ◽  
Structured Interview ◽  
Communication Style ◽  
Decision Making Process ◽  
Medical Team ◽  
Interview Guide ◽  
Surrogate Decision ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is an unexpected event that can render patients incapable of decision-making, requiring a surrogate decision maker (SDM), most often a family member, to be engaged. Yet how SDMs understand the information provided, and how they view their experience of making decisions for cardiac arrest patients is not well understood. Methods: This inductive qualitative study utilized data from semi-structured open-ended interviews with SDMs for OHCA patients. SDMs were approached: 1) at the bedside for consent to contact; and 2) 30 days after discharge/death to consent to interview. Interviews were conducted using a semi-structured interview guide, recorded, and transcribed for analysis. Transcripts were read in entirety and thematically coded by two investigators. Results: Over a 5-month period (1/18-5/18), 7 SDMs consented; however, 11 individuals were interviewed, as 3 SDMs invited family members to join the interviews. SDMs were living spouses (2), adult children (2), a parent (1) and siblings (2). Within this sample, 71.4% (5/7) of SDMs decided to withdraw life sustaining therapy or discontinue resuscitative efforts for their family member. Overall, experiences varied dramatically, with some families reporting a positive experience and others clearly reporting concerns about how the decision making process occurred. Major themes identified that affected the experience of decision-making include how SDMs perceived provider communication style, how they processed medical uncertainty from the providers, confidence in their decisions, and finally, conflict/discordance between the medical team and family. Families identified the following factors that might improve the decision making process for future SDMs; 1) updated “goals for the day”; 2) access to medical records; 3) Access to protocols for post-arrest patients; 4) a consistent liaison to the medical team; 5) consistent messaging amongst the care team. Conclusions: In this sample of SDMs, experiences with decision-making were variable. Notably, communication factors predominated in SDMs experience with decision-making. Finally, multiple important factors were identified to assist future SDMs in decision making for post-OHCA patients.

Latinas’ Amniocentesis Decision-Making Process Semi-Structured Interview Guide

2011 ◽  
Author(s):  
Sarah Guerra Seth ◽  
Thomas Goka ◽  
Andrea Harbison ◽  
Lisa Hollier ◽  
Susan Peterson ◽  
...  
Keyword(s):  
Decision Making ◽  
Structured Interview ◽  
Decision Making Process ◽  
Interview Guide

scholarly journals THE ROLE OF SOCIAL MEDIA ON MIGRATION DECISION-MAKING PROCESSES: Case of Indonesian Student in University of Groningen

2018 ◽  
Vol 6 (1) ◽  
pp. 515
Author(s):  
Inayah Hidayati
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Migration Decision ◽  
Decision Making Process ◽  
Migration Behavior ◽  
Interview Guide ◽  
Destination Area ◽  
Decision Making Processes ◽  
The Impact

Objective: This research aims to explain the impact of social media on the migration decision-making process of Indonesian student migrants in University of Groningen who used a social media account. In detail, this research will consider the role of social media in the migration decision-making process of students who emigrated from Indonesia and how they uses social media in the context of the migration decision-making process. Methods: The data collected included qualitative data from in-depth interviews and supported by study literatures. An interview guide was formulated to facilitate the indepth interviews and generate a better understanding of migration behavior. Expectation: Social media help Indonesian student migrants on migration decision making process and they use social media for searching information about destination area. Result: Student migrant in University of Groningen use their social media to gain information before they choose that university for study. They use Facebook to making contact with their friends and collagues in the destination country. Student group on Facebook help Indonesian student to get information about school and daily life.

Air pollution and activation of mobile medical team for out-of-hospital cardiac arrest

2015 ◽  
Vol 33 (3) ◽  
pp. 367-372 ◽  
Author(s):  
Catherine Pradeau ◽  
Virginie Rondeau ◽  
Emilie Lévèque ◽  
Pierre-Yves Guernion ◽  
Eric Tentillier ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cardiac Arrest ◽  
Medical Team ◽  
Hospital Cardiac Arrest

Balancing Between Closeness and Distance: Emergency Medical Services Personnel’s Experiences of Caring for Families at Out-of-Hospital Cardiac Arrest and Sudden Death

2012 ◽  
Vol 27 (1) ◽  
pp. 42-52 ◽  
Author(s):  
Anders Bremer ◽  
Karin Dahlberg ◽  
Lars Sandman
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Sudden Death ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Family Members ◽  
Family Care ◽  
Emergency Medical ◽  
Bereaved Family ◽  
Hospital Cardiac Arrest

AbstractIntroduction: Out-of-hospital cardiac arrest (OHCA) is a lethal health problem that affects between 236,000 and 325,000 people in the United States each year. As resuscitation attempts are unsuccessful in 70-98% of OHCA cases, Emergency Medical Services (EMS) personnel often face the needs of bereaved family members.Problem: Decisions to continue or terminate resuscitation at OHCA are influenced by factors other than patient clinical characteristics, such as EMS personnel’s knowledge, attitudes, and beliefs regarding family emotional preparedness. However, there is little research exploring how EMS personnel care for bereaved family members, or how they are affected by family dynamics and the emotional contexts. The aim of this study is to analyze EMS personnel’s experiences of caring for families when patients suffer cardiac arrest and sudden death.Methods: The study is based on a hermeneutic lifeworld approach. Qualitative interviews were conducted with 10 EMS personnel from an EMS agency in southern Sweden.Results: The EMS personnel interviewed felt responsible for both patient care and family care, and sometimes failed to prioritize these responsibilities as a result of their own perceptions, feelings and reactions. Moving from patient care to family care implied a movement from well-structured guidance to a situational response, where the personnel were forced to balance between interpretive reasoning and a more direct emotional response, at their own discretion. With such affective responses in decision-making, the personnel risked erroneous conclusions and care relationships with elements of dishonesty, misguided benevolence and false hopes. The ability to recognize and respond to people’s existential questions and needs was essential. It was dependent on the EMS personnel’s balance between closeness and distance, and on their courage in facing the emotional expressions of the families, as well as the personnel’s own vulnerability. The presence of family members placed great demands on mobility (moving from patient care to family care) in the decision-making process, invoking a need for ethical competence.Conclusion: Ethical caring competence is needed in the care of bereaved family members to avoid additional suffering. Opportunities to reflect on these situations within a framework of care ethics, continuous moral education, and clinical ethics training are needed. Support in dealing with personal discomfort and clear guidelines on family support could benefit EMS personnel.

scholarly journals Citizen bystander–patient relationship and 1-month outcomes after out-of-hospital cardiac arrest of cardiac origin from the All-Japan Utstein Registry: a prospective, nationwide, population-based, observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e024715 ◽  
Author(s):  
Yasunori Suematsu ◽  
Bo Zhang ◽  
Takashi Kuwano ◽  
Hideto Sako ◽  
Masahiro Ogawa ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Observational Study ◽  
Family Member ◽  
Neurological Outcome ◽  
Patient Characteristics ◽  
Neurological Impairment ◽  
Population Based ◽  
Public Access ◽  
Secondary Outcome ◽  
Hospital Cardiac Arrest

ObjectivesThe presence of a bystander witness is a crucial predictor of patient survival after out-of-hospital cardiac arrest (OHCA). However, the differences in survival and neurological outcomes among different types of citizen bystanders are not well understood.DesignWe analysed data from the All-Japan Utstein Registry, a prospective, nationwide, population-based, observational study that was started in January 2005.SettingThe registry includes all patients with OHCA who were transported to the hospital by emergency medical service (EMS) in Japan. The type of citizen bystander was classified as family member, friend, colleague, passerby or other.ParticipantsWe analysed 210 642 patients in the registry who were 18 years or older and experienced OHCA of cardiac origin witnessed by a citizen bystander between 2005 and 2014.Primary and secondary outcome measuresThe main outcomes were 1 month survival and 1 month survival with minimal neurological impairment.ResultsOf the citizen bystander-witnessed cases, 65.1% (137 147/210 642) were witnessed by a family member. However, among patients who survived to 1 month and who had a favourable 1 month neurological outcome, much lower proportions (53.9% (10 907/20 239) and 48.9% (5722/11 696)) were witnessed by a family member. Witness by a friend, colleague or passerby was associated with good 1 month neurological function, after controlling for the patient’s age, first recorded rhythm, gender, bystander cardiopulmonary resuscitation (CPR), use of a public-access automated external defibrillator, dispatcher instructions, collapse-call time and response time compared with witness by a family member (friend: OR 1.35, 95% CI 1.24 to 1.46, colleague: OR 1.63, 95% CI 1.33 to 1.98, passerby: OR 1.60, 95% CI 1.39 to 1.84).ConclusionsOne-month survival and favourable1 month neurological outcome of patients with OHCA of cardiac origin witnessed by a family member were worse than those in cases witnessed by a friend, colleague or passerby, independent of the patient characteristics and the response of EMS.

Abstract 12789: Development of the Tool to EMPOwer Surrogate Decision Makers of Comatose Survivors of Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Sarah M Perman ◽  
Bonnie J Siry-Bove ◽  
Benjamin Abella ◽  
Stacie L Daugherty ◽  
Edward Havranek ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Decision Aid ◽  
Reading Level ◽  
Decision Makers ◽  
Structured Interviews ◽  
Patient Decision ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Grade Reading Level

Introduction: Surrogate decision makers (SDMs) for comatose survivors of cardiac arrest are often charged with making time-sensitive complex decisions with regard to life-sustaining therapies in a sudden critical illness. We describe the development of a decision aid for SDMs of comatose survivors of cardiac arrest. Methods: Applying recommendations from the International Patient Decision Aid Standards, we developed this decision aid iteratively with the purpose to educate families on post-arrest care and evidence based decision-making. We obtained feedback from stakeholders, including surrogate decision makers, patients, caregivers, nurses and physicians, in focus groups and semi-structured interviews. Results: Informed by interviews with SDMs and the AHA Guidelines, we designed a prototype of the decision aid. Each iteration resulted in a refined version of the aid (Figure). Step 1 included feedback from the Shared Decision-Making Core at the Adult and Child Consortium on Outcomes Research and Delivery Science (ACCORDS). Step 2 incorporated feedback from the ACCORDS Community Engagement Stakeholder group. Step 3 consisted of 10 semi-structured interviews with informal caregivers and patient pairs within the Advanced Heart Failure or Seniors clinics. The document was then reviewed by a team of expert cardiac arrest stakeholders. The aid includes key definitions, a timeline of post-arrest care, factors that support decisions to discontinue or pursue life sustaining therapies, commonly asked questions and an illustration of a patient undergoing post-arrest treatment. The decision aid, entitled T ool to EMPO wer (TEMPO) Surrogate Decision Makers, is written at a 7 th grade reading level. Conclusions: Through a robust iterative process, we designed a decision aid for SDMs of comatose survivors of cardiac arrest. The aid is intended to support the decision to pursue or forego further life-sustaining therapy and to be informative about post-arrest care.

End-of-Life Decision-Making in Pediatric Oncology

2019 ◽  
pp. 736-748
Author(s):  
Deborah A. Lafond ◽  
Katherine Patterson Kelly
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Healthcare Providers ◽  
Communication Style ◽  
Serious Illness ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
End Of Life Decision ◽  
Informed Patient ◽  
Life Decision

Decision-making for parents facing the serious illness of a child is difficult, particularly when facing end-of-life decisions. Healthcare providers can influence patients’ and parents’ end-of-life decision-making involvement by communication style and timing of the discussion. Children and adolescents need assistance making decisions based on their cognitive development, which necessitates the assessment of each patient’s competence and preference for decision involvement. Competence and preference for decision-making should also be explored for parents and other surrogate decision-makers. Preferences for treatment should be balanced between the child or adolescent and the caregiver or surrogate. Nurses have a professional responsibility to facilitate informed patient and surrogate decision-making at the end of life.

What would people think? Perceived social norms, willingness to serve as a surrogate, and end-of-life treatment decisions

2020 ◽  
pp. 1-9
Author(s):  
Rachael Spalding ◽  
JoNell Strough ◽  
Barry Edelstein
Keyword(s):  
Decision Making ◽  
Mechanical Ventilation ◽  
End Of Life ◽  
Contextual Factors ◽  
Medical Decision ◽  
Decision Making Process ◽  
Surrogate Decision Making ◽  
Willingness To Serve ◽  
Surrogate Decision ◽  
End Of Life Treatment

Abstract Background Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. Method An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments. Results Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. Significance of results The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making — the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates’ confidence in their decisions.

PARAMEDIC RESUSCITATION DECISION-MAKING IN OUT OF HOSPITAL CARDIAC ARREST: AN EXPLORATORY STUDY

2016 ◽  
Vol 33 (9) ◽  
pp. e11.3-e12
Author(s):  
Janet Brandling ◽  
Kim Kirby ◽  
Sarah Black ◽  
Sarah Voss ◽  
Jonathan Benger
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Exploratory Study ◽  
Hospital Cardiac Arrest
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