title: The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person.
abstract: OBJECTIVE
  In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.
  
  
  METHODS
  We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.
  
  
  RESULTS
  Among 144 staff, 128 were contacted; 99 completed the questionnaire (77% response rate; 20 physicians [11 residents], 51 nurses, 28 nurse's aides). Items classed as most important attributes for a reference person were knowledge of patient's wishes and values, emotional attachment, adequate understanding of the clinical history, and designation as a surrogate before admission. There were no significant differences according to respondent's age, job title, or experience.
  
  
  CONCLUSIONS
  Caregivers identify a reference person based on criteria such as knowledge of the patient's wishes, emotional bond with the patient, an adequate understanding of the clinical history, and designation as surrogate before admission.
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: JRigaud@ch-dieppe.fr.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Rigaud
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: jeanbaptistehardy@hotmail.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Hardy
authors.affiliation: Department of Intensive Care, François Mitterrand University Hospital, 21079 Dijon, France; UMR 7366 CNRS, University of Burgundy, Dijon, France. Electronic address: nicolas.meunier-beillard@u-bourgogne.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meunier-Beillard
authors.affiliation: Department of Internal Medicine, François Mitterrand University Hospital, 21079 Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France. Electronic address: herve.devilliers@chu-dijon.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Devilliers
authors.affiliation: Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France. Electronic address: fiona.ecarnot@univ-fcomte.fr.
authors.forename: Fiona
authors.initials: F
authors.lastname: Ecarnot
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: cquesnel@ch-dieppe.fr.
authors.forename: Corinne
authors.initials: C
authors.lastname: Quesnel
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: sgelinotte@ch-dieppe.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Gelinotte
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: pldeclercq@ch-dieppe.fr.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Declercq
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: jeraldi@ch-dieppe.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Eraldi
authors.affiliation: Department of Intensive Care, Dieppe General Hospital, 76202 Dieppe, France. Electronic address: fbougerol@ch-dieppe.fr.
authors.forename: François
authors.initials: F
authors.lastname: Bougerol
authors.affiliation: Department of Intensive Care, François Mitterrand University Hospital, 21079 Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France; Lipness Team, INSERM Research Center UMR 866, University of Burgundy, Dijon, France. Electronic address: jean-pierre.quenot@chu-dijon.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010344:Patient Advocacy; D010820:Physicians; D019727:Proxy / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Ethics; Intensive care; Questionnaire; Surrogate