Association between shared decision-making during family meetings and surrogates' trust in their ICU physician

Author Department

Pulmonary/Critical Care Medicine

Document Type

Article, Peer-reviewed

Publication Date



Background: Although trust is central to successful clinician-family relationships in intensive care units (ICUs), little is known about how to promote surrogates' trust of ICU clinicians in this setting.

Research question: Does the conduct of family conferences and clinicians' use of shared decision-making (SDM) within family conferences impact surrogates' trust in the clinician?

Study design and methods: Mixed methods secondary analysis of a multi-center prospective cohort study of 369 surrogate decision-makers of 204 decisionally incapacitated patients at high risk of death or severe functional impairment within 13 ICUs at 6 U.S. medical centers between 2008 and 2012. Surrogates completed the Abbreviated Wake Forest Physician Trust Scale (range 5-25) before and after an audio-recorded family conference conducted within 5 days of ICU admission. We qualitatively coded transcribed conferences to determine clinicians' use of 5 SDM behaviors: discussing surrogate's role, explaining medical condition and prognosis, providing emotional support, assessing understanding, and eliciting patient's values and preferences. Using multivariable linear regression with adjustment for clustering, we assessed whether surrogates' trust in the physician increased after the family meeting; we also examined whether the number of SDM behaviors used by clinicians during the family meeting impacted trust scores.

Results: In adjusted models, conduct of a family meeting was associated with increased trust (average change pre-to-post: 0.91-points (95% CI 0.4-1.4, P-value<0.01)). Every additional element of SDM used during the family meeting, including discussing surrogate's role, providing emotional support, assessing understanding, and eliciting patient's values and preferences, was associated with a 0.37-point increase in trust (95% CI 0.08-0.67, P-value=0.01). If all 4 elements were used trust increased by 1.48-points. Explaining medical condition or prognosis was observed in nearly every conference (98.5%) and excluded from the final model.

Interpretation: The conduct of family meetings and clinicians' use of SDM behaviors during meetings were both associated with increases in surrogates' trust in the treating clinician.

Keywords: Communication; Decision Making; Goals of Care; Intensive Care; Qualitative Methods; Shared; Trust.