Surrogate Decision Makers' Perspectives on Family Members' Prognosis after Intracerebral Hemorrhage.

Autor:	Zahuranec DB; 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan., Anspach RR; 3 Department of Sociology, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, Michigan., Roney ME; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan., Fuhrel-Forbis A; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan., Connochie DM; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan., Chen EP; 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan., Thompson BB; 4 Department of Neurology, Alpert Medical School at Brown University , Providence, Rhode Island.; 5 Department of Neurosurgery, Alpert Medical School at Brown University , Providence, Rhode Island., Varelas PN; 6 Department of Neurology and Neurosurgery, Henry Ford Hospital , Detroit, Michigan., Morgenstern LB; 1 Stroke Program, Department of Neurology, Michigan Medicine , Ann Arbor, Michigan.; 7 Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan.; 8 Department of Emergency Medicine, Michigan Medicine , Ann Arbor, Michigan., Fagerlin A; 2 Center for Bioethics and Social Sciences in Medicine , Michigan Medicine, Ann Arbor, Michigan.; 9 Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City, Utah.; 10 Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS) , Salt Lake City, Utah.
Jazyk:	angličtina
Zdroj:	Journal of palliative medicine [J Palliat Med] 2018 Jul; Vol. 21 (7), pp. 956-962. Date of Electronic Publication: 2018 Apr 02.
DOI:	10.1089/jpm.2017.0604
Abstrakt:	Background: Surrogate communication with providers about prognosis in the setting of acute critical illness can impact both patient treatment decisions and surrogate outcomes. Objectives: To examine surrogate decision maker perspectives on provider prognostic communication after intracerebral hemorrhage (ICH). Design: Semistructured interviews were conducted and analyzed qualitatively for key themes. Setting/subjects: Surrogate decision makers for individuals admitted with ICH were enrolled from five acute care hospitals. Results: Fifty-two surrogates participated (mean age = 54, 60% women, 58% non-Hispanic white, 13% African American, 21% Hispanic). Patient status at interview was hospitalized (17%), in rehabilitation/nursing facility (37%), deceased (38%), hospice (4%), or home (6%). Nineteen percent of surrogates reported receiving discordant prognoses, leading to distress or frustration in eight cases (15%) and a change in decision for potentially life-saving brain surgery in three cases (6%). Surrogates were surprised or confused by providers' use of varied terminology for the diagnosis (17%) (e.g., "stroke" vs. "brain hemorrhage" or "brain bleed") and some interpreted "stroke" as having a more negative connotation. Surrogates reported that physicians expressed uncertainty in prognosis in 37%; with physician certainty in 56%. Surrogate reactions to uncertainty were mixed, with some surrogates expressing a negative emotional response (e.g., anxiety) and others reporting understanding or acceptance of uncertainty. Conclusions: Current practice of prognostic communication in acute critical illness has many gaps, leading to distress for surrogates and variability in critical treatment decisions. Further work is needed to limit surrogate distress and improve the quality of treatment decisions.
Databáze:	MEDLINE
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