College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, USA.
Departments of Neurology and Neurosurgery, Alpert Medical School at Brown University, Providence, USA.
Neurocrit Care. 2021 Feb;34(1):193-200. doi: 10.1007/s12028-020-01018-x.
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.
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.
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).
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.
背景/目的：对于患有脑出血（ICH）的患者，其替代决策者经常被要求就使用维持生命的治疗方法做出艰难的决定。我们使用经过验证的措施，在一项前瞻性多中心研究中，探讨了 ICH 替代决策者对决策的满意度和决策后悔的体验。
2015 年 9 月至 2016 年 12 月，从 3 家医院招募非创伤性 ICH 病例，并邀请替代决策者完成自我管理的调查。主要结局是 ICU 家庭满意度量表（FSICU-DM）的 10 项决策子量表（范围 0-100，分数越高满意度越高），次要结局是决策后悔量表（范围 0-100，分数越高后悔感越强）。使用手动后向选择，使用线性回归模型评估满意度与预先指定的协变量之间的关联。
共有 73 名代理人被邀请参与（亲自或通过邮件），其中 48 名代理人返回了一份完整的调查问卷（中位数代理人年龄 60.5 岁，63%为女性，77%为白人）。患者的中位年龄为 72.5 岁，54%为女性，入院时格拉斯哥昏迷量表中位数为 10 分，院内死亡率为 31%，56%有院内 DNR 医嘱。医生通常会就脑部手术或过渡到舒适治疗方案做出治疗建议（>50%），但很少就 DNR 医嘱做出建议（<20%）。替代决策者对决策的满意度普遍较高（FSICU-DM 中位数为 85，IQR 57.5-95）。多变量分析中与更高满意度相关的因素包括更多地使用共同决策（P<0.0001）、患者年龄较小（p=0.02）、ICH 评分 3 或更高（p=0.03）和替代决策者关系（配偶与其他，p=0.02）。DNR 医嘱的时间与满意度无关（P>0.25）。决策后悔评分通常较低（中位数 12.5，IQR 0-31.3）。
考虑到 ICH 的严重程度和突发性，令人欣慰的是，替代决策者对决策的满意度普遍较高，后悔感普遍较低。然而，仍需要更多的工作来定义适当的结果衡量标准和最佳的 ICH 患者替代决策者研究招募方法。
