This observational study by Torke et al.1 assessed the impact of communication quality on decision-making, psychological well-being, and satisfaction for surrogates of hospitalized older adults. The authors used the information and emotional support sub-scales of the Family Inpatient Communication Survey to assess communication quality. In this study, emotional support lowered the odds of anxiety, depression, and post-traumatic stress, and increased surrogate perception of the quality of decision-making. Information increased the odds of post-traumatic stress but also increased surrogate satisfaction.

High rates of depression and post-traumatic stress have been reported in family members of ICU patients and surrogates making end-of-life decisions.2 The study by Torke et al. extends this finding to surrogates of non-ICU patients and to non-life sustaining decisions such as procedures and nursing home placement (29% reported depression and 14.6% reported post-traumatic stress). This is an important finding and suggests the need for a better support system and follow-up of surrogate decision-makers. One possible intervention might involve encouraging surrogate decision-makers to talk to their primary care provider to screen for depression and post-traumatic stress disorder (PTSD).

This is an observational study and thus cannot prove causality for increased emotional support leading to less psychological distress. However, it adds to the body of literature showing that empathy during communication improves compliance and outcomes,3 and improves physician satisfaction and reduces burnout.4 Providing adequate information for decision-making is emphasized during medical training, but many training programs do not formally teach emotional aspects of patient communication.5 For physicians, this study suggests that attention to emotional aspects of communication, in addition to high-quality information, helps to reduce psychological distress and improve satisfaction among surrogates of hospitalized adults.