Preliminary Identification of Coping Profiles Relevant to Surrogate Decision Making in the ICU.
OBJECTIVE
The Intensive Care Unit (ICU) is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience.


METHODS
Participants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual's ICU experience. Quality of life was measured by the EQ-5D, personality dimensions were examined with the abbreviated Big Five inventory, coping with stress was assessed with Brief COPE. Shared decision making preferences were assessed by the Degner Control Preferences Scale (CPS) and information seeking style was assessed with the Miller Behavioral Style Scale (MBSS). Social support was examined using an abbreviated version of the Social Relationship Index. Participants also completed a vignette-based simulated ICU experience, in which they made a surrogate decision on behalf of a loved one in the ICU.


RESULTS
Three hundred forty-three participants completed the study. Three distinct coping profiles were identified: adaptive copers, maladaptive copers, and disengaged copers. Profiles differed primarily on coping styles, personality, quality of their closest social relationship, and history of anxiety and depression. Responses to the simulated ICU decision making experience differed across profiles. Disengaged copers (15%) were more likely to elect to refuse dialysis on behalf of an adult sibling compared to adaptive copers (7%) or maladaptive copers (5%) (p = 0.03). Notably, the MBSS and the CPS did not differ by coping profile.


CONCLUSIONS
Distinct coping profiles are associated with differences in responses to a simulated ICU experience. Tailoring communication and support to specific coping profiles may represent an important pathway to improving ICU experience for patients and families.
Geriatric Research Education and Clinical Center (GRECC), George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, United States of America.|Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, Utah, United States of America.|Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.
Jorie M
JM
Butler
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Department of Internal Medicine, Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America.|Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States of America.
Eliotte L
EL
Hirshberg
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, United States of America.
Ramona O
RO
Hopkins
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.
Emily L
EL
Wilson
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Department of Internal Medicine, Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America.
James F
JF
Orme
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Department of Internal Medicine, Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America.
Sarah J
SJ
Beesley
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Homer Warner Center for Informatics Research, Murray, Utah, United States of America.
Kathryn
K
Kuttler
Center for Humanizing Critical Care, Intermountain Healthcare, Murray, Utah, United States of America.|Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America.|Department of Internal Medicine, Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America.
Samuel M
SM
Brown
D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000503:physiopathology; D016638:Critical Illness; D003657:Decision Making; D003863:Depression / Q000503:physiopathology; D005190:Family; D005260:Female; D006801:Humans; D007206:Individuality; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires