title: Decision-making in the ICU: perspectives of the substitute decision-maker.
abstract: OBJECTIVE
  To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making.
  
  
  METHODS
  Prospective, multicenter, cohort study.
  
  
  METHODS
  Six Canadian university-affiliated ICUs.
  
  
  METHODS
  We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h.
  
  
  METHODS
  None.
  
  
  RESULTS
  A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites.
  
  
  CONCLUSIONS
  In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.
authors.affiliation: Department of Medicine, Angada 3, Kingston General Hospital, Ontario, Canada. dkh2@post.queensu.ca
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Graeme M
authors.initials: GM
authors.lastname: Rocker
authors.forename: Peter M
authors.initials: PM
authors.lastname: Dodek
authors.forename: Demetrios J
authors.initials: DJ
authors.lastname: Kutsogiannis
authors.forename: Sharon
authors.initials: S
authors.lastname: Peters
authors.forename: Joan E
authors.initials: JE
authors.lastname: Tranmer
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Callaghan
mesh_terms: D002170:Canada; D003258:Consumer Behavior; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011368:Professional-Family Relations; D011446:Prospective Studies