Anxiety and depression in family members of ICU patients: ethical considerations regarding decision-making capacity

Objective: This study investigated symptoms of anxiety and depression in relatives of patients admitted in the Intensive Care Unit and determined whether these symptoms were associated to the seriousness of the patients’ condition.Metodology: A total of 102 patients’ relatives were surveyed during the study. They were given a self-report questionnaire in order to assess demographic data, anxiety and depression symptoms. The symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (hads). Patient’s condition was evaluated with a.p.a.ch.e ii Score.Results: More than 60% of patients’ relatives presented severe symptoms of anxiety and depression. No relation was found between symptoms of anxiety and depression of the relatives of patients and patients’ condition of health. On the contrary, these feelings used to exist regardless of the seriousness of patient’s condition.Conclusions: The assessment of these patients is recommended in order serious problems of anxiety and depression to be prevented.

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Decision-making capacity and surrogate designation in French ICU patients

Intensive Care Medicine ◽

10.1007/s001340100982 ◽

2001 ◽

Vol 27 (8) ◽

pp. 1360-1364 ◽

Cited By ~ 46

Author(s):

E. Ferrand ◽

A.-C. Bachoud-Levi ◽

M. Rodrigues ◽

S. Maggiore ◽

C. Brun-Buisson ◽

...

Keyword(s):

Decision Making ◽

Icu Patients ◽

Decision Making Capacity

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Medical Decision-Making Capacity and Ethical Considerations

Elder Abuse ◽

10.1007/978-3-319-47504-2_12 ◽

2017 ◽

pp. 229-246

Author(s):

Elizabeth J. Santos ◽

Corey Nichols-Hadeed

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Medical Decision ◽

Ethical Considerations ◽

Decision Making Capacity

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Assessment of satisfaction with care and decision-making among English and Spanish-speaking family members of neuroscience ICU patients

Applied Nursing Research ◽

10.1016/j.apnr.2015.02.002 ◽

2016 ◽

Vol 29 ◽

pp. 262-267 ◽

Cited By ~ 5

Author(s):

Thomas A. Hagerty ◽

Ángela Velázquez ◽

J. Michael Schmidt ◽

Cristina Falo

Keyword(s):

Decision Making ◽

Family Members ◽

Satisfaction With Care ◽

Icu Patients ◽

Spanish Speaking

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Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study

BMJ Open ◽

10.1136/bmjopen-2021-050134 ◽

2021 ◽

Vol 11 (8) ◽

pp. e050134

Author(s):

Nina Wubben ◽

Mark van den Boogaard ◽

JG van der Hoeven ◽

Marieke Zegers

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Family Members ◽

Decision Making Process ◽

Shared Decision ◽

Icu Patients ◽

Qualitative Interview Study ◽

Icu Physicians ◽

Close Family

ObjectiveTo identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.DesignQualitative study.SettingTwo Dutch tertiary centres.Participants19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.ResultsThree themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.ConclusionsInterviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.

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Informed Consent and Decision-Making Capacity in Neuromodulation: Ethical Considerations

Neuromodulation Technology at the Neural Interface ◽

10.1111/j.1525-1403.2008.00161.x ◽

2008 ◽

Vol 11 (3) ◽

pp. 156-162

Author(s):

Ron L. P. Berghmans

Keyword(s):

Decision Making ◽

Informed Consent ◽

Ethical Considerations ◽

Decision Making Capacity

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Research with bereaved families

Nursing Ethics ◽

10.1177/0969733014521097 ◽

2014 ◽

Vol 21 (8) ◽

pp. 946-955 ◽

Cited By ~ 19

Author(s):

Magi Sque ◽

Wendy Walker ◽

Tracy Long-Sutehall

Keyword(s):

Decision Making ◽

Ethical Decision ◽

Ethical Decision Making ◽

Family Members ◽

Ethical Considerations ◽

Participant Recruitment ◽

Related Research ◽

Follow Up Care ◽

Bereavement Research

Theoretical debates about the nature of grief and bereavement draw attention to the sensitivity of carrying out research with bereaved people, the possible threats that this may pose and the ethical considerations required to ameliorate potentially damaging outcomes. The authors of this article present a framework for ethical decision-making that has been successfully developed in the context of research with bereaved families. The discussion focuses on application and evaluation of the framework during research with family members who were approached about the donation of a deceased relative’s organs and/or tissues for transplantation. Practical strategies of relevance to the processes of participant recruitment, the interview encounter and follow-up care in the post-interview period are identified and discussed. Concerns about the possible impact of bereavement research are balanced with the views of family members who gave credence to the therapeutic and cathartic benefits of participating in sensitive, death-related research.

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Best Practices, Enduring Challenges, and Opportunities for SED by AD

Voluntarily Stopping Eating and Drinking ◽

10.1093/med/9780190080730.003.0013 ◽

2021 ◽

pp. 241-248

Author(s):

Timothy E. Quill ◽

Paul T. Menzel ◽

Thaddeus M. Pope ◽

Judith K. Schwarz

Keyword(s):

Decision Making ◽

Best Practices ◽

Advance Directive ◽

Family Members ◽

Decision Making Capacity ◽

Challenges And Opportunities

SED by AD begins with an advance directive specifying what eating and drinking limitations the person desires if decision-making capacity is lost and when to begin them. Both written and video instructions are recommended. SED by AD potentially prevents a preemptive choice to VSED by those still enjoying life but wanting to avoid a prolonged dementia death. Challenges to implementation include uncertainty about legality, and concerns about a patient’s possible ‘change of mind’ once capacity is lost. Family members and caregivers may become distressed about how to respond to subsequent requests for food or fluid. Should caregivers respond to the ‘then’ capacitated person who previously completed the directive or the ‘now’ incapacitated person who seems to want oral feedings? Ideally an AD for SED also articulates how caregivers should respond to apparent desires for fluids. Comfort feeding only (CFO) should be the ‘back up’ plan if SED by AD proves to be too difficult for the patient or caregivers.

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