Rethinking Regret: Reappraisal Tendencies Buffer Regret for ICU Surrogates Following Patient Death.

Area of Science:

• Critical Care Medicine
• Psychology
• Decision Science

Background:

• Over half of surrogate decision-makers experience regret after making decisions for patients in intensive care units (ICUs).
• Patient death increases the risk of surrogate decision-maker regret.
• Emotion regulation tendencies may buffer this risk.

Purpose of the Study:

• To investigate the influence of patient survival outcome (alive/deceased) on surrogate decision-maker regret.
• To examine how cognitive reappraisal tendencies mitigate the risk of decision regret.

Main Methods:

• Secondary analysis of 158 surrogate decision-makers from a randomized controlled trial in 4 ICUs.
• Measurement of cognitive reappraisal tendency at enrollment and decision regret at 90 days post-enrollment.
• Logistic regression used to analyze the association between survival outcome, decision regret, and the moderating role of cognitive reappraisal.

Main Results:

• Fifty percent of surrogate decision-makers reported decision regret.
• Surrogates of deceased patients had 5.7 times greater odds of regret compared to surrogates of survivors.
• A one standard deviation increase in cognitive reappraisal tendency was associated with a four-fold reduction in regret odds among surrogates of deceased patients.

Conclusions:

• Surrogate decision-makers for deceased patients are more likely to experience regret.
• Increased tendency for cognitive reappraisal is associated with decreased odds of regret.
• Interventions promoting cognitive reappraisal may improve psychological outcomes for surrogate decision-makers in critical care.