SOCIAL NETWORK CHARACTERISTICS AND PREFERENCES FOR INFORMATION AS A SUBSTITUTE DECISION MAKER IN AN INTENSIVE CARE UNIT SIMULATION

Purpose:

This study was conducted to understand how reported quality of relationships and size of social networks, an important source of stress buffering, relate to information preferences during a vignette-based simulation of substitute decision making in the Intensive Care Unit (ICU).

Method:

A group of 331 community-dwelling participants completed a web-based version of the Social Relationship Index detailing information about their social network and characterizing the supportiveness, aversiveness, indifference, and ambivalence of a variety of social ties including family members, significant others, and co-workers.  Participants also completed a vignette-based simulation in which they decided on behalf of an adult sibling in the ICU. In the vignette, the sibling’s condition worsens, and respondents indicate what information was most important to receive from the physician, selecting from 7 response options including information relating to the likelihood of the patient surviving, discomfort expected in intubation and mechanical ventilation, how the physician would choose in similar circumstances, and questions about the patients expected quality of life. 

Result:

Analysis of Variance (ANOVA) was conducted to examine quality of relationships and the social network size in relation to information preferences endorsed in the simulated vignette.  The number of supportive, ambivalent, aversive or indifferent social relationships was unrelated to information preferences.  The number of total relationships reported did, however, relate to information preference (F (6, 312) = 2.88; p = .01.  Respondents who reported a higher number of social network members were more likely to endorse information preferences surrounding likelihood of survival, discomfort, and quality of life.  Individuals who reported fewer social network members were more likely to endorse physician-dependent information preferences (e.g., “What the doctor would do in this situation if (the patient) were his/her sister”).  

Conclusion:

  These results suggest that some aspects of social network characteristics may relate to the experience of substitute decision making in the stressful ICU context.  Potentially, substitute decision makers with larger social networks may be more comfortable participating in substitute decision making whereas decision makers with smaller social networks may feel less comfortable engaging on behalf of a loved one, in a simulated ICU experience.  Further exploration of the relationship between social network characteristics and the experience of ICU substitute decision making is indicated.