Decision‐making among the substitute decision makers in intensive care units: An investigation of decision control preferences and decisional conflicts. (14th July 2020)

• Record Type: Journal Article
• Authors: Wu, Feixia; Zhuang, Yiyu; Chen, Xiangping; Wen, Huan; Tao, Wenwen; Lao, Yuewen; Zhou, Hongchang
• Is Part Of: Journal of advanced nursing. Volume 76:Number 9(2020)
• Page Start: 2323
• Page End: 2335
• Publication Date: 2020-07-14
• Subjects: decision control preferences -- decisional conflict -- decision‐making -- intensive care units -- nurse -- surrogates; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14451
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aims: To explore decision control preferences and decisional conflicts and to analyse their association among the surrogate decision makers in the intensive care unit. Design: The study carried out a cross‐sectional survey among the surrogates. Methods: The participants were 115 surrogate decision makers of critical patients, from August to September 2019. A Chi‐squared test and logistic regression were used to assess decision control preferences and decisional conflicts, and Spearman's rank correlation coefficient was employed to examine their association. Results: Of the 115 surrogate decision makers, 51.3% preferred a collaborative role, and 63.48% were somewhat unsure about making decisions. Logistic regression analysis identified decision control preferences was associated with surrogates' age, education level, and personality traits, while decisional conflicts was associated with surrogates' age, education level, character, medical expense burden, and Acute Physiology and Chronic Health Evaluation‐II score. Cohen's kappa statistics showed a bad concordance of decision‐making expectations and actuality, with kappa values of 0.158 ( p < .05). Wherein surrogates who experienced discordance between their preferred and actual roles, have relatively higher decisional conflicts. Conclusion: This study identified individual differences of surrogate decision makers in decision control preferences and decisional conflicts. These results imply that incorporation of the individual decision preferences and communication styles into care plans is an important first step to develop high quality decision support. Impact: This research is a contribution to the limited study on decision control preferences and decisional conflicts among surrogate decision makers of critically ill patients. Moreover based on the investigation of understanding the status and related factors of decision preferences and decisional conflicts set the stage for developing effective decision support interventions. Abstract : 目的: 旨在探讨决策控制偏好和决策冲突, 并分析决策控制偏好和决策冲突在重症监护室替代决策者中的关联性。 设计: 该研究对替代者进行了横断面调查。 方法: 参与者为2019年8月至9月期间115名危重患者的替代决策者。采用卡方检验和逻辑回归来评估决策控制偏好和决策冲突, 并采用斯皮尔曼等级相关系数考察其关联性。 结果: 在这115名替代决策者中, 51.3%的人更倾向于合作角色, 而63.48%的人则对决策不太确定。逻辑回归分析发现, 决策控制偏好与替代决策者的年龄、教育水平、性格特征相关, 而决策冲突与替代决策者的年龄、教育水平、性格、医疗费用负担、急性生理和慢性健康评价‐II评分相关。Cohen的kappa统计量显示, 决策期望与实际值不太一致, kappa值为0.158( p < .05)。其中经历过偏好角色和实际角色不协调的替代决策者, 其决策冲突相对更高。 结论: 该研究确定了替代决策者在决策控制偏好和决策冲突方面的个体差异。这些结果意味着, 将个人决策偏好和沟通方式纳入护理计划是制定高质量决策支持措施的重要的第一步。 影响: 该研究对危重患者替代决策者决策控制偏好和决策冲突的有限研究作出了一定贡献。此外, 基于对决策偏好和决策冲突的现状及相关因素的调查了解, 为制定有效的决策支持干预措施奠定了基础。