title: Dimensions and Role-Specific Mediators of Surrogate Trust in the ICU.
abstract: OBJECTIVE
  In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU.
  
  
  METHODS
  Prospective qualitative study.
  
  
  METHODS
  Medical ICU of a major urban university hospital.
  
  
  METHODS
  Surrogate decision makers of intubated, mechanically ventilated patients in the medical ICU.
  
  
  RESULTS
  Semistructured interviews focused on surrogates' general experiences in the ICU and on their trust in the clinicians caring for the patient. Interviews were audio-recorded, transcribed verbatim, and coded by two reviewers. Constant comparison was used to identify themes pertaining to trust. Thirty surrogate interviews revealed five dimensions of trust in ICU clinicians: technical competence, communication, honesty, benevolence, and interpersonal skills. Most surrogates emphasized the role of nurses in trust formation, frequently citing their technical competence. Trust in physicians was most commonly related to honesty and the quality of their communication with surrogates.
  
  
  CONCLUSIONS
  Interventions to improve trust in the ICU should be role-specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust. Further research is needed to confirm our findings and explore the impact of trust modification on clinician-family conflict.
authors: 1Division of Pulmonary and Critical Care, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.2Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL.3Division of Pulmonary and Critical Care, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.4Division of Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.5Buehler Center on Aging, Health & Society, Feinberg School of Medicine, Northwestern University, Chicago, IL.6Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL.7Jesse Brown Veterans Affairs Medical Center, Department of Medicine, Chicago, IL.
authors: Paul J
authors: PJ
authors: Hutchison
authors: Katie
authors: K
authors: McLaughlin
authors: Tom
authors: T
authors: Corbridge
authors: Kelly N
authors: KN
authors: Michelson
authors: Linda
authors: L
authors: Emanuel
authors: Peter H S
authors: PH
authors: Sporn
authors: Megan
authors: M
authors: Crowley-Matoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D019727:Proxy / Q000523:psychology*; D036301:Qualitative Research; D020458:Third-Party Consent; D035502:Trust / Q000523:psychology; D055815:Young Adult