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Surrogate Satisfaction with Decision Making After Intracerebral Hemorrhage

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Abstract

Background/Objective

Surrogate decision makers for patients with intracerebral hemorrhage (ICH) are frequently asked to make difficult decisions on use of life-sustaining treatments. We explored ICH surrogate satisfaction with decision making and experience of decision regret using validated measures in a prospective multicenter study.

Methods

Cases of non-traumatic ICH were enrolled from three hospitals (September 2015–December 2016), and surrogate decision makers were invited to complete a self-administered survey. The primary outcome was the 10-item decision-making subscale of the Family Satisfaction in the Intensive Care Unit scale (FSICU-DM, range 0–100, higher is greater satisfaction), and the secondary outcome was the decision regret scale (range 0–100, higher is greater regret). Linear regression models were used to assess the association between satisfaction with decision making and pre-specified covariates using manual backward selection.

Results

A total of 73 surrogates were approached for participation (in person or mail), with 48 surrogates returning a completed survey (median surrogate age 60.5 years, 63% female, 77% white). Patients had a median age of 72.5, 54% were female, with a median admission Glasgow coma scale of 10, in-hospital mortality of 31%, and 56% with an in-hospital DNR order. Physicians commonly made treatment recommendation (> 50%) regarding brain surgery or transitions to comfort measures, but rarely made recommendations (< 20%) regarding DNR orders. Surrogate satisfaction with decision making was generally high (median FSICU-DM 85, IQR 57.5–95). Factors associated with higher satisfaction on multivariable analysis included greater use of shared decision making (P < 0.0001), younger patient age (p = 0.02), ICH score of 3 or higher (p = 0.03), and surrogate relationship (spouse vs. other, p = 0.02). Timing of DNR orders was not associated with satisfaction (P > 0.25). Decision regret scores were generally low (median 12.5, IQR 0–31.3).

Conclusions

Considering the severity and abruptness of ICH, it is reassuring that surrogate satisfaction with decision making was generally high and regret was generally low. However, more work is needed to define the appropriate outcome measures and optimal methods of recruitment for studies of surrogate decision makers of ICH patients.

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Funding

This study was funded by the National Institute on Aging of the National Institutes of Health (award number K23AG038731) and the National Institute of Neurological Disorders and Stroke (award numbers R01NS38916 and R01NS070941). Database support was provided by the Michigan Institute for Clinical & Health Research (CTSA: UL1RR024986). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This study was performed at the University of Michigan Health System (Ann Arbor, Michigan), Henry Ford Hospital (Detroit, Michigan), Rhode Island Hospital (Providence, Rhode Island), and the Corpus Christi Medical Center and CHRISTUS Spohn hospitals, CHRISTUS Health system (Corpus Christi, Texas).

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Author notes

  1. Savina Sahgal and Aneesha Yande have contributed equally to this work.

Authors and Affiliations

  1. College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, USA

    Savina Sahgal & Aneesha Yande

  2. Departments of Neurology and Neurosurgery, Alpert Medical School at Brown University, Providence, USA

    Bradford B. Thompson

  3. Stroke Program, Department of Neurology, University of Michigan Medical Center, 1500 E Medical Center Dr. CVC 3392, SPC 5855, Ann Arbor, MI, 48109-5855, USA

    Emily P. Chen, Lewis B. Morgenstern & Darin B. Zahuranec

  4. Center for Bioethics and Social Sciences in Medicine, Michigan Medicine, Ann Arbor, USA

    Emily P. Chen, Angela Fagerlin & Darin B. Zahuranec

  5. Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA

    Angela Fagerlin

  6. Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, USA

    Angela Fagerlin

  7. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, USA

    Lewis B. Morgenstern

  8. Department of Emergency Medicine, Michigan Medicine, Ann Arbor, USA

    Lewis B. Morgenstern

Authors
  1. Savina Sahgal
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  2. Aneesha Yande
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  3. Bradford B. Thompson
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  4. Emily P. Chen
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  5. Angela Fagerlin
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  6. Lewis B. Morgenstern
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  7. Darin B. Zahuranec
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Corresponding author

Correspondence to Darin B. Zahuranec.

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Conflict of interest

Several authors have received funding from the NIH to study surrogate decision making after stroke, including R01NS0911112 (Dr. Zahuranec and Dr. Morgenstern) and R21 NR016332 (Dr. Zahuranec and Dr. Fagerlin). The authors report that there are no other conflicts of interest.

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Sahgal, S., Yande, A., Thompson, B.B. et al. Surrogate Satisfaction with Decision Making After Intracerebral Hemorrhage. Neurocrit Care 34, 193–200 (2021). https://doi.org/10.1007/s12028-020-01018-x

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  • DOI: https://doi.org/10.1007/s12028-020-01018-x

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