Associations of surrogates' death-preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life

Qualitative analysis of concordance in advance care planning discussions between patients with advanced cancer and their surrogate decision makers

OBJECTIVES

This study aimed to explore the concordance in advance care planning (ACP) discussions between patients with advanced cancer and surrogate decision makers within an oncology ward.

DESIGN

Purposive and snowball sampling methods were used in this qualitative study, which involved conducting semistructured interviews to gather patients with advanced cancer and their surrogate decision makers. Interpretative phenomenological analysis was performed on the interview data to identify commonalities and differences in ACP discussions and to explore the factors influencing these differences.

SETTING

The research was conducted in the oncology ward of a tertiary hospital located in Foshan, China.

PARTICIPANTS

Participants included a total of 15 pairs of patients with advanced cancer and their surrogate decision makers in oncology wards.

RESULTS

Interpretative phenomenological analysis yielded three main themes and fourteen subthemes. The identified themes were: (1) personal factor; (2) family intrinsic factors and (3) external factor.

CONCLUSION

This study revealed the consistency of ACP between patients with advanced cancer and their surrogate decision makers in China and its influencing factors. Future research should further explore family-centred ACP practices, delve into how family factors influence the implementation of ACP for patients and develop conceptual frameworks and implementation strategies for ACP that align with Chinese cultural values and healthcare systems. These efforts will contribute to enhancing understanding in clinical practice, advancing scientific research and guiding policy formulation. ACP holds promise as a crucial intervention to improve the quality of end-of-life care for patients with advanced cancer in China, playing a central role in the field of palliative care in the country.

Decision threshold models in medical decision making: a scoping literature review

BACKGROUND

Decision thresholds play important role in medical decision-making. Individual decision-making differences may be attributable to differences in subjective judgments or cognitive processes that are captured through the decision thresholds. This systematic scoping review sought to characterize the literature on non-expected utility decision thresholds in medical decision-making by identifying commonly used theoretical paradigms and contextual and subjective factors that inform decision thresholds.

METHODS

A structured search designed around three concepts-individual decision-maker, decision threshold, and medical decision-was conducted in MEDLINE (Ovid) and Scopus databases from inception to July 2023. ProQuest (Dissertations and Theses) database was searched to August 2023. The protocol, developed a priori, was registered on Open Science Framework and PRISMA-ScR guidelines were followed for reporting on this study. Titles and abstracts of 1,618 articles and the full texts for the 228 included articles were reviewed by two independent reviewers. 95 articles were included in the analysis. A single reviewer used a pilot-tested data collection tool to extract study and author characteristics, article type, objectives, theoretical paradigm, contextual or subjective factors, decision-maker, and type of medical decision.

RESULTS

Of the 95 included articles, 68 identified a theoretical paradigm in their approach to decision thresholds. The most common paradigms included regret theory, hybrid theory, and dual processing theory. Contextual and subjective factors that influence decision thresholds were identified in 44 articles.

CONCLUSIONS

Our scoping review is the first to systematically characterizes the available literature on decision thresholds within medical decision-making. This study offers an important characterization of the literature through the identification of the theoretical paradigms for non-expected utility decision thresholds. Moreover, this study provides insight into the various contextual and subjective factors that have been documented within the literature to influence decision thresholds, as well as these factors juxtapose theoretical paradigms.

Decision Self-Efficacy and Decisional Conflict on Reintubation among Surrogates of Ventilated Patients Undergoing Planned Extubation

PURPOSE

Although the medical decision-making process can be overwhelming for some surrogates, there is a lack of understanding regarding their experiences. The objectives of this study were to examine the decision self-efficacy and decisional conflict experienced by surrogates in intensive care units (ICUs) when faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation. In addition, predictors and mediators influencing these decision-making processes were identified.

METHODS

This study utilized a cross-sectional design to investigate the decision-making processes of 174 surrogates who were faced with the decision of whether to reintubate patients with respiratory failure after a planned extubation in the internal ICU of a medical center between August 2021 and February 2022. Structured questionnaires were administered to collect data on the surrogates' background information, decision self-efficacy, decisional conflict, and positive and negative affect. The patients' background information was also collected. Univariate and multivariate analyses were performed to model the data.

RESULTS

The mean decision self-efficacy score of the surrogates was 82.41 points, and 20.7% surrogates had decisional conflict scores exceeding 37.5 points, suggesting that they faced challenges in the decision-making process. Surrogates' employment status and negative affect significantly predicted their decision self-efficacy. In addition, patients' activities of daily living prior to hospitalization and the decision self-efficacy of the surrogate significantly predicted surrogate decisional conflict. The impact of surrogates' negative affect on decisional conflict was fully mediated by decision self-efficacy.

CONCLUSIONS

Surrogate decision self-efficacy mediates the relationship between negative affect and decisional conflict. Providing clinical care interventions that focus on enhancing surrogate self-efficacy and reducing negative affect can help alleviate decisional conflict in this population.