Exploring determinants of surrogate decision-maker confidence: an example from the ICU

Area of Science:

• Bioethics
• Clinical Research
• Medical Sociology

Background:

• Intensive care unit (ICU) patients often require surrogate decision-makers for medical choices, including research participation.
• Understanding factors influencing surrogate confidence is crucial for ethical genetic research involving vulnerable populations.

Purpose of the Study:

• To explore determinants of surrogate decision-maker confidence in representing ICU patients' wishes for genetic research.
• To examine the relationship between surrogate and patient confidence levels.
• To assess if increased confidence correlates with agreement on research participation.

Main Methods:

• Exploratory data analysis of survey data from 445 surrogates and 214 patients across three hospital ICUs.
• Comparison of patient and surrogate confidence in the surrogate's ability to represent patient wishes.
• Analysis of factors influencing surrogate self-confidence and agreement with patient preferences.

Main Results:

• Patient confidence in surrogates is solely influenced by prior discussions.
• Surrogate self-confidence is affected by multiple factors.
• More confident surrogates demonstrate greater alignment with patient wishes.
• Patients are more willing than surrogates to consent to genetic research participation.
• Lower surrogate confidence was linked to distrust of staff, reluctance for non-beneficial research, less consideration of research conduct, and lack of a personal trusted decision-maker.

Conclusions:

• Prior communication is key for patient trust in surrogates for ICU genetic research.
• Surrogate confidence is multifaceted and impacts decision-making alignment.
• Addressing surrogate-specific concerns may improve concordance in research participation decisions.