Exploring Determinants of Surrogate Decision-Maker Confidence An Example From the ICU

• Published in: Journal of empirical research on human research ethics Vol. 9; no. 4; pp. 76 - 85
• Main Authors: Bolcic-Jankovic, Dragana, Clarridge, Brian R., LeBlanc, Jessica L., Mahmood, Rumel S., Roman, Anthony M., Freeman, Bradley D.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Sage Publications, Ltd 01.10.2014; SAGE Publications; Sage Publications Ltd
• Subjects: Adolescent; Adult; Age; Aged; Communication; Confidence; Critical Care; Data analysis; Decision Making; Female; Genes; Genetic Research; Humans; Informed Consent; Intensive care; Intensive Care Units; Male; Medical genetics; Medical research; Middle Aged; Nurses; Patient Selection; Patients; Proxy; Research ethics; Research Subjects; Surveys and Questionnaires; Trust; White people; Young Adult; critical care; agreement; patient; confidence; surrogate decision maker
• ISSN: 1556-2646; 1556-2654
• DOI: 10.1177/1556264614545036

This article is an exploratory data analysis of the determinants of confidence in a surrogate decision maker who has been asked to permit an intensive care unit (ICU) patient’s participation in genetic research. We pursue the difference between surrogates’ and patients’ confidence that the surrogate can accurately represent the patient’s wishes. The article also explores whether greater confidence leads to greater agreement between patients and surrogates. Our data come from a survey conducted in three hospital ICUs. We interviewed 445 surrogates and 214 patients. The only thing that influences patients’ confidence in their surrogate’s decision is whether they had prior discussions with him or her; however, there are more influences operating on the surrogate’s self-confidence. More confident surrogates are more likely to match their patients’ wishes. Patients are more likely to agree to research participation than their surrogates would allow. The surrogates whose response did not match as closely were less trusting of the hospital staff, were less likely to allow patient participation if there were no direct benefits to the patient, had given less thought about the way genetic research is conducted, and were much less likely to have a person in their life who they would trust to make decisions for them if they were incapacitated.