Decisions about Life Sustaining Treatments (LST) occur frequently and contribute significantly to Medicare program spending; they are frequently misaligned with patient preferences; they have an enormous impact on health outcomes for patients and families; and they are central to the nation’s futility debate.
By focusing upon this complex clinical decision problem, the proposed research has relevance to patient care and broader policy issues. I hypothesize that the surrogate’s emotional state influence LST decisions. We will conduct two randomized, crossover factorial experiments to explore the relationship of experimentally-induced emotional state (hot, cold) and physician communication skill on surrogates’ simulated decisions to forgo LST. 240 adult surrogates will participate in a webbased interactive video and survey during which they will role-play a code status decision for a critically ill patient.
We will use guided imagery to artificially induce a state of attachment to the patient (parent or spouse) prior to participating in the web-based family meeting when the subject is randomized to the hot state. Experimental variables include hot or cold affective state and communication behaviors of the physician. The primary outcome is the surrogate’s decision. Secondary outcomes are decisional conflict and correlation with the family member's preference.
To assess correlation with the family member's preference, each subject will be invited e-mail their family member with a URL linking back to the last question on their survey. Covariables include self-reported measures of emotional arousal, comprehension of medical information, trust in physicians, and prior experience and beliefs about ICU care.