Dispositional Cognitive Appraisal, Informational Coping Style, and Depressive Symptoms in Family Decision Makers of the Chronically Critically Ill

2008 ◽  
Vol 30 (8) ◽  
pp. 1024-1025
Author(s):  
Ronald L. Hickman ◽  
Barbara J. Daly
Keyword(s):  
Depressive Symptoms ◽  
Critically Ill ◽  
Coping Style ◽  
Cognitive Appraisal ◽  
Decision Makers ◽  
Family Decision ◽  
Chronically Critically Ill

scholarly journals Informational Coping Style and Depressive Symptoms in Family Decision Makers

2010 ◽  
Vol 19 (5) ◽  
pp. 410-420 ◽  
Author(s):  
Ronald L. Hickman ◽  
Barbara J. Daly ◽  
Sara L. Douglas ◽  
John M. Clochesy
Keyword(s):  
Depressive Symptoms ◽  
Coping Style ◽  
Coping Styles ◽  
Depression Scale ◽  
Secondary Data ◽  
Family Satisfaction ◽  
Role Stress ◽  
Demographic Characteristics ◽  
Decision Makers ◽  
Family Decision

Background Overwhelmed family decision makers of chronically critically ill patients must comprehend vital information to make complex treatment decisions that are consistent with patients’ preferences. Exploration of informational coping styles of family decision makers may yield evidence for tailored communication practices supporting the psychological and informational needs of family decision makers. Objectives To describe patterns in the demographic characteristics and informational coping styles of family decision makers; to assess differences in informational satisfaction, role stress, and depressive symptoms between family decision makers classified as monitors and as blunters; and to describe the predictive associations between informational coping styles, informational satisfaction, and role stress on depressive symptoms in family decision makers. Methods A secondary data analysis of 210 family decision makers of cognitively impaired patients who required 3 days or more of mechanical ventilation. On enrollment, decision makers completed the abbreviated Miller Behavioral Style Scale to assess informational coping styles, the Critical Care Family Satisfaction Survey’s informational subscale to assess informational satisfaction, a single-item measure of role stress, and the Center for Epidemiological Studies Depression scale to assess depressive symptoms. Results No associations emerged between demographic characteristics and informational coping styles of family decision makers. Monitors had higher depression scores than did blunters. Both information coping style and informational satisfaction influenced depressive symptoms; however, role stress was the most significant predictor. Conclusions Family decision makers classified as monitors were at higher risk for depression than were those who seem to avoid information. Targeting monitors with additional psychological and informational support may mitigate their psychological impairment.

scholarly journals A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill

2019 ◽  
Vol 18 (5) ◽  
pp. 537-543
Author(s):  
Grant A. Pignatiello ◽  
Elliane Irani ◽  
Sadia Tahir ◽  
Emily Tsivitse ◽  
Ronald L. Hickman
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Self Efficacy ◽  
Internal Consistency Reliability ◽  
Decision Makers ◽  
Validity And Reliability ◽  
Family Decision ◽  
Surrogate Decision Makers ◽  
Family Decision Making ◽  
Surrogate Decision

AbstractObjectivesThe purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE).MethodsA convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients.ResultsThe exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates.Significance of resultsThis is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

How Long Does (S)He Have? Retrospective Analysis of Outcomes After Palliative Extubation in Elderly, Chronically Critically Ill Patients

2016 ◽  
Vol 44 (6) ◽  
pp. 1138-1144 ◽  
Author(s):  
Cynthia X. Pan ◽  
Dimitris Platis ◽  
Min Min Maw ◽  
Jane Morris ◽  
Simcha Pollack ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronically Critically Ill

Post–Intensive Care Syndrome in Family Decision Makers of Long-term Acute Care Hospital Patients

2017 ◽  
Vol 26 (5) ◽  
pp. 416-422 ◽  
Author(s):  
Amy Petrinec
Keyword(s):  
Quality Of Life ◽  
Intensive Care ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Summary Score ◽  
Decision Makers ◽  
Family Decision ◽  
Post Intensive Care Syndrome

Background Family members of critically ill patients experience indications of post–intensive care syndrome, including anxiety, depression, and posttraumatic stress disorder. Despite increased use of long-term acute care hospitals for critically ill patients, little is known about the impact of long-term hospitalization on patients’ family members. Objectives To examine indications of post–intensive care syndrome, coping strategies, and health-related quality of life among family decision makers during and after patients’ long-term hospitalization. Methods A single-center, prospective, longitudinal descriptive study was undertaken of family decision makers of adult patients admitted to long-term acute care hospitals. Indications of post–intensive care syndrome and coping strategies were measured on the day of hospital admission and 30 and 60 days later. Health-related quality of life was measured by using the Short Form-36, version 2, at admission and 60 days later. Results The sample consisted of 30 family decision makers. On admission, 27% reported moderate to severe anxiety, and 20% reported moderate to severe depression. Among the decision makers, 10% met criteria for a provisional diagnosis of posttraumatic stress disorder. At admission, the mean physical summary score for quality of life was 47.8 (SD, 9.91) and the mean mental summary score was 48.00 (SD, 10.28). No significant changes occurred during the study period. Problem-focused coping was the most frequently used coping strategy at all time points. Conclusion Family decision makers of patients in long-term acute care hospitals have a significant prevalence of indications of post–intensive care syndrome.

scholarly journals Correlates of Cognitive Load in Surrogate Decision Makers of the Critically III

2018 ◽  
Vol 41 (5) ◽  
pp. 650-666 ◽  
Author(s):  
Grant A. Pignatiello ◽  
Ronald L. Hickman
Keyword(s):  
Emotion Regulation ◽  
Cognitive Load ◽  
Critically Ill ◽  
Decision Aids ◽  
Cross Sectional Study ◽  
Decision Makers ◽  
Expressive Suppression ◽  
Cross Sectional ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Surrogate decision makers (SDMs) of the critically ill experience intense emotions and transient states of decision fatigue. These factors may increase the cognitive load experienced by electronic decision aids. This cross-sectional study explored the associations of emotion regulation (expressive suppression and cognitive reappraisal) and decision fatigue with cognitive load (intrinsic and extraneous) among a sample of 97 SDMs of the critically ill. After completing subjective measures of emotion regulation and decision fatigue, participants were exposed to an electronic decision aid and completed a subjective measurement of cognitive load. Multiple regression analyses indicated that decision fatigue predicted intrinsic cognitive load and expressive suppression predicted extraneous cognitive load. Emotion regulation and decision fatigue represent modifiable determinants of cognitive load among SDMs exposed to electronic decision aids.

scholarly journals Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses to Reduce Nonbeneficial Intensive Care Unit Treatments: Protocol for a Multicenter Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Dong Chang ◽  
Jennifer Parrish ◽  
Nader Kamangar ◽  
Janice Liebler ◽  
May Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Care Planning ◽  
Improvement Strategy ◽  
Icu Patients ◽  
Family Meetings ◽  
Planning Approach ◽  
Icu Physicians

BACKGROUND Invasive intensive care unit (ICU) treatments for patients with advanced medical illnesses and poor prognoses may prolong suffering with minimal benefit. Unfortunately, the quality of care planning and communication between clinicians and critically ill patients and their families in these situations are highly variable, frequently leading to overutilization of invasive ICU treatments. Time-limited trials (TLTs) are agreements between the clinicians and the patients and decision makers to use certain medical therapies over defined periods of time and to evaluate whether patients improve or worsen according to predetermined clinical parameters. For patients with advanced medical illnesses receiving aggressive ICU treatments, TLTs can promote effective dialogue, develop consensus in decision making, and set rational boundaries to treatments based on patients’ goals of care. OBJECTIVE The aim of this study will be to examine whether a multicomponent quality-improvement strategy that uses protocoled TLTs as the default ICU care-planning approach for critically ill patients with advanced medical illnesses will decrease duration and intensity of nonbeneficial ICU care without changing hospital mortality. METHODS This study will be conducted in medical ICUs of three public teaching hospitals in Los Angeles County. In Aim 1, we will conduct focus groups and semistructured interviews with key stakeholders to identify facilitators and barriers to implementing TLTs among ICU patients with advanced medical illnesses. In Aim 2, we will train clinicians to use protocol-enhanced TLTs as the default communication and care-planning approach in patients with advanced medical illnesses who receive invasive ICU treatments. Eligible patients will be those who the treating ICU physicians consider to be at high risk for nonbeneficial treatments according to guidelines from the Society of Critical Care Medicine. ICU physicians will be trained to use the TLT protocol through a curriculum of didactic lectures, case discussions, and simulations utilizing actors as family members in role-playing scenarios. Family meetings will be scheduled by trained care managers. The improvement strategy will be implemented sequentially in the three participating hospitals, and outcomes will be evaluated using a before-and-after study design. Key process outcomes will include frequency, timing, and content of family meetings. The primary clinical outcome will be ICU length of stay. Secondary outcomes will include hospital length of stay, days receiving life-sustaining treatments (eg, mechanical ventilation, vasopressors, and renal replacement therapy), number of attempts at cardiopulmonary resuscitation, frequency of invasive ICU procedures, and disposition from hospitalization. RESULTS The study began in August 2017. The implementation of interventions and data collection were completed at two of the three hospitals. As of September 2019, the study was at the postintervention stage at the third hospital. We have completed focus groups with physicians at each medical center (N=29) and interviews of family members and surrogate decision makers (N=18). The study is expected to be completed in the first quarter of 2020, and results are expected to be available in mid-2020. CONCLUSIONS The successful completion of the aims in this proposal may identify a systematic approach to improve communication and shared decision making and to reduce nonbeneficial invasive treatments for ICU patients with advanced medical illnesses. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16301

Overtreatment of Neonates

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 169-169
Author(s):  
ALAN R. FLEISCHMAN
Keyword(s):  
New York ◽  
Critically Ill ◽  
Recent Article ◽  
New York Times ◽  
Decision Makers ◽  
Rescue Fantasies

To the Editor.— Dr William Silverman's recent article entitled "Overtreatment of Neonates? A Personal Retrospective"1 is a thoughtful and provocative addition to the debate on the method to decide how much treatment is appropriate for critically ill and tiny babies. He basically believes that parents should be the decision makers and that the appropriate decision is the withholding of aggressive treatments from infants at the threshold of viability. He adds his voice to others who would criticize the paternalistic physicians who ignore the values of families and merely fulfill their own "rescue fantasies (New York Times.

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