A PATH MODEL OF FACTORS THAT INFLUENCE SATISFACTION WITH DECISION SUPPORT AMONG SURROGATE DECISION MAKERS OF THE CHRONICALLY CRITICALLY ILL

Purpose:   The acuity of the chronically critically ill (CCI) and the increased rates of cognitive impairment in this emerging cohort enhances the complexity of shared decision making. Often surrogate decision makers (SDMs) are required to make complex health care decisions without certainty of the patient’s likelihood of survival or long-term quality of life. This cross-sectional study examines dispositional and situational factors that influence the satisfaction with decision support among SDMs of cognitively impaired CCI patients.

Methods:    A dispositional stress and coping framework guided the development of the path model and analysis of survey data collected from 216 SDMs of the CCI. A path model was created with Analysis of Moment Structure (AMOS version 19), which consisted of the following dispositional and situational factors: dispositional cognitive appraisal (threat, resources, and centrality subscales of the Stress Appraisal Measure), informational coping style (monitor subscale of the Abbreviated Miller Behavioral Style Scale), depressive symptoms (Center for Epidemiological Studies-Depression Scale), role stress (“How stressful has it been making decisions for your loved one?”), satisfaction with decision support (informational and decision support subscale of the revised Critical Care Family Satisfaction Survey for chronic critical illness), and the SDM’s gender.

Results:    On average, SDMs (mean age = 52 years) were Caucasian (62%), females (76%), high school educated (65%) and the spouse (34%), adult child (28%), or parent (22%) of a cognitively impaired CCI patient. Overall, the path model had an excellent model fit to our data (χ²= 14.9, df = 20, p=.78, TLI = 1.07, CFI = 1.00, RMSEA =.000). Threat appraisal (β=.40, p<.001) had a direct effect on informational coping style, and threat appraisal was correlated with centrality (r =.68, p<.001) and resources (r =-.20, p<.01). Gender (β=-.15, p<.05), informational coping style (β=.17, p<.05), and threat appraisal (β=.21, p<.05) had a direct effect on depressive symptoms. Depressive symptoms (β=.45, p<.001) had a direct effect on role stress, and role stress (β=-.14, p=.05) had a direct effect on satisfaction with decision support.

Conclusion:    Among SDMs of CCI patients, role stress directly impacts their appraisal of satisfaction with decision support. Interventional research that targets threat appraisal, adapts to informational coping style, and reduces depressive symptoms may reduce the SDM’s perception of role stress and enhance satisfaction with decision support.