Background: In severe stroke, prognostic uncertainty creates challenges for surrogates when asked to maintain or forego life-sustaining treatments for seriously-ill patients. Surrogates experience adverse psychological symptoms associated with decisional conflict surrounding end-of-life (EoL) decision making. A 2013 IOM report maintains that quality of care can be improved by integrating patients and caregivers into decision making at every possible level.
Purpose: This review was performed to identify levels of evidence in studies of decision aids (DAs) on surrogate decision making in critical illness; determine the feasibility and acceptability of DAs to facilitate EoL surrogate decision making for acutely-ill stroke patients; and evaluate the outcomes of DAs for EoL surrogate decision making for severe stroke patients.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to generate literature pertaining to DAs used to facilitate surrogate decision making in critical illness. Final keywords used included: “decision aid or decision tool”, “surrogate decision making or family decision making”, and “prognosis or outcome or recovery”. The total number of articles produced was 607 via CINAHL and PubMed. Inclusion/exclusion criteria were used to identify articles of relevance. Following screening, nine studies were selected. Monthly searches will continue to identify current literature.
Results: Research designs ranged from pilot studies to randomized controlled trials. Four trials provided direction: one was performed in an ICU with patients with prolonged mechanical ventilation; two examined a DA to facilitate goals of care for advanced dementia patients; and one evaluated a video aid to determine the accuracy of surrogate decision making. No studies explored the use of a DA for critically-ill stroke patients.
Conclusion: There is a need to investigate the feasibility and acceptability of a DA aimed to reduce psychological symptoms in surrogates for critically-ill stroke patients by promoting shared EoL decision making and reducing decisional conflict as well as regret.