Decision-making in the ICU: perspectives of the substitute decision-maker.
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.
Heyland
Daren K
DK
Department of Medicine, Angada 3, Kingston General Hospital, Ontario, Canada. dkh2@post.queensu.ca
Cook
Deborah J
DJ
Rocker
Graeme M
GM
Dodek
Peter M
PM
Kutsogiannis
Demetrios J
DJ
Peters
Sharon
S
Tranmer
Joan E
JE
O'Callaghan
Christopher J
CJ
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