Differences in Assessing Surrogate Understanding of the Patient's Clinical Situation

Background: One of the key communication skills in shared decision-making is assessing a surrogate's understanding of a patient's clinical situation, which can help facilitate surrogate comprehension and encourage surrogates to share their perspectives. There is uncertainty around best practices for assessing surrogate understanding in shared decision-making to guide training in communication skills. Objective: We sought to determine what questions clinicians used to ask surrogates about the patient's current clinical situation and how surrogates responded. Methods: Twenty-seven audio recordings of clinician-surrogate conversations about adult patients who were unable to make their own life-or-death decisions and who being cared for by four clinical teams at two hospitals in the Midwest were qualitatively analyzed using conversation analysis. Ten conversations included clinician questions soliciting surrogate understanding of the patient's situation. Patterns of how surrogates responded to different clinician questions were examined. Results: There were differences in how surrogates responded to various types of clinician solicitations of their understanding. Asking what the surrogates have heard led to a retelling of statements and assessments of the patient's situation. Asking what they know or what has happened led to surrogates responding with a timeline of events. In contrast, asking what is going on or what they understand led to surrogates sharing a more "big-picture" understanding. Conclusion: We found that there were differences in how surrogates responded to different clinician solicitations of their understanding. Real-world implications of different strategies, along with surrogate perspectives of those strategies, should be investigated further to elucidate best practices that can be incorporated into communication skills training.