Health-care system distrust in the intensive care unit

Area of Science:

• Medical Sociology
• Health Services Research
• Critical Care Medicine

Background:

• Patient surrogates in intensive care units (ICUs) play a crucial role in decision-making.
• Understanding surrogate perceptions of the healthcare system is vital for effective communication and care.
• The Revised Health Care System Distrust Scale (RHCSDS) is a tool to assess these perceptions.

Purpose of the Study:

• To evaluate the performance and psychometric properties of the RHCSDS in the ICU setting.
• To assess the reliability and validity of the scale when used with surrogates of critically ill patients.

Main Methods:

• A pilot, prospective cohort study involving 50 surrogates of mechanically ventilated ICU patients.
• Surrogates were surveyed on days 1, 3, and 7 of the patient's ICU admission.
• Factor analysis and Cronbach's alpha were used to assess the scale's structure and internal consistency.

Main Results:

• The RHCSDS demonstrated high internal consistency (Cronbach's α = .83 overall).
• Factor analysis revealed a two-factor structure: values and competence.
• Health-care system distrust was inversely correlated with trust in ICU physicians (r = -.63) and decreased over the ICU stay.

Conclusions:

• The RHCSDS is a reliable and valid instrument for measuring health care system distrust among ICU surrogates.
• Surrogate distrust in the healthcare system is substantial but can decrease during the ICU stay.
• Findings support the use of the RHCSDS to understand surrogate perspectives in critical care.