The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person

In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.

We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.

Among 144 staff, 128 were contacted; 99 completed the questionnaire (77% response rate; 20 physicians [11 residents], 51 nurses, 28 nurse's aides). Items classed as most important attributes for a reference person were knowledge of patient's wishes and values, emotional attachment, adequate understanding of the clinical history, and designation as a surrogate before admission. There were no significant differences according to respondent's age, job title, or experience.

Caregivers identify a reference person based on criteria such as knowledge of the patient's wishes, emotional bond with the patient, an adequate understanding of the clinical history, and designation as surrogate before admission.