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

More than half of surrogate decision-makers experience regret after making decisions for a patient in the intensive care unit (ICU). This risk is enhanced following patient death yet may be buffered by their emotion regulation tendencies.

We investigated how a patient's survival outcome (alive/deceased) influenced their surrogate decision-maker's risk of developing decision regret and how their cognitive reappraisal tendencies for emotion regulation mitigate this risk.

Using data collected from a randomized controlled trial, we performed a secondary analysis of 158 surrogate decision-makers for incapacitated, mechanically ventilated adults within 4 ICUs at a tertiary medical center. We measured cognitive reappraisal tendency at study enrollment and decision regret 90 days post-enrollment. Adjusting for individual and process-related factors, we used logistic regression to examine the association between a patient's survival outcome and their risk of experiencing decision regret and the moderating role of cognitive reappraisal tendency on this relationship.

Fifty percent of surrogate decision-makers reported decision regret. Surrogates of deceased patients had 5.7 times greater odds of regret than those of survivors. Among these surrogates, a 1 standard deviation increase in their cognitive reappraisal tendency was associated with a 4-fold reduction in their odds of experiencing regret.

Surrogate decision-makers of decedents are more likely to experience regret. These odds decrease as the surrogate's tendency to use cognitive reappraisal increases. Reappraisal-based interventions could improve psychological outcomes for surrogate decision-makers, highlighting a novel opportunity for targeted support in critical care settings.