Investigating conflict in ICUs-is the clinicians' perspective enough?

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Health Communication

Background:

• Physician-surrogate conflict in intensive care units (ICUs) is often studied from the clinician's viewpoint.
• Surrogate decision-makers' perceptions of conflict may differ significantly from those of physicians.
• Limited research exists on the concordance between physicians and surrogates regarding conflict in critical care settings.

Purpose of the Study:

• To determine the level of agreement between physicians and surrogate decision-makers concerning conflict in the ICU.
• To identify factors that predict physician-surrogate conflict.
• To explore discrepancies in conflict perception between clinicians and surrogates.

Main Methods:

• Prospective cohort study conducted in four ICUs across two San Francisco hospitals.
• Data collected from 230 surrogate decision-makers and 100 physicians for 175 critically ill patients.
• Utilized questionnaires for conflict perception, communication attitudes, κ scores for concordance, and multivariate modeling for predictor identification.

Main Results:

• Conflict was identified by either party in 63% of cases, with physicians less likely to perceive it (27.8%) than surrogates (42.3%).
• Agreement on conflict presence between physicians and surrogates was poor (κ = 0.14).
• Surrogate satisfaction with physician bedside manner inversely correlated with conflict; perceived discrimination by surrogates positively correlated with conflict.

Conclusions:

• Conflict between physicians and surrogates is a common occurrence in ICUs.
• There is a notable lack of agreement between physicians and surrogates regarding the occurrence of conflict.
• Future research should incorporate both clinician and surrogate perspectives to develop better methods for assessing and addressing conflict.