title: Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.
abstract: BACKGROUND
  Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients.
  
  
  OBJECTIVE
  To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU.
  
  
  METHODS
  Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews.
  
  
  CONCLUSIONS
  The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition.
  
  
  CONCLUSIONS
  The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs.
authors.affiliation: Boston College, William F. Connell School of Nursing, Chestnut Hill, MA. Electronic address: dionneod@uab.edu.
authors.forename: J Nicholas
authors.initials: JN
authors.lastname: Dionne-Odom
authors.affiliation: Boston College, William F. Connell School of Nursing, Chestnut Hill, MA.
authors.forename: Danny G
authors.initials: DG
authors.lastname: Willis
authors.affiliation: University of Alabama at Birmingham, School of Nursing, Birmingham, AL.
authors.forename: Marie
authors.initials: M
authors.lastname: Bakitas
authors.affiliation: Applied Research Associates, Inc, Cognitive Solutions Division, Fairborn, OH.
authors.forename: Beth
authors.initials: B
authors.lastname: Crandall
authors.affiliation: Boston College, William F. Connell School of Nursing, Chestnut Hill, MA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Grace
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D015331:Cohort Studies; D003422:Critical Care; D003657:Decision Making; D004644:Emotions; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D013647:Task Performance and Analysis; D013727:Terminal Care; D020458:Third-Party Consent
keywords: Cognitive task analysis; End of life; Intensive care unit; Palliative care; Qualitative; Surrogate decision making