by Sarah K.
Andersen, Rachel A. Butler, Chung-Chou H. Chang, Robert Arnold, Derek C. Angus
and Douglas B. White
Critical Care volume 27,
Article number: 61 (2023)
Background
Whether surrogate decision makers regret decisions about the
use of life support for incapacitated, critically ill patients remain
uncertain. We sought to determine the prevalence of decision regret among
surrogates of adult ICU patients and identify factors that influence regret.
Methods
We conducted a secondary analysis of data from the PARTNER 2
trial, which tested a family support intervention for surrogates of critically
ill adults. At 6-month follow-up, surrogates rated their regret about life
support decisions using the Decision Regret Scale (DRS), scored from 0 to 100,
with higher scores indicating more regret. We used multiple linear regression
to identify covariates associated with decision regret based on a psychological
construct of regret. We constructed two models using the full cohort; model 1
included patient outcomes; model 2 focused on covariates known at the time of
ICU decision-making. Subgroup analyses were also conducted based on patient
survival status at hospital discharge and 6-month follow-up.
Results
748 of 848 surrogates had complete DRS data. The median
(IQR) DRS score was 15 (0, 25). Overall, 54% reported mild regret (DRS 5–25),
19% moderate-strong regret (DRS 30–100), and 27% no regret (DRS 0). Poor
patient outcome at 6 months (death or severe functional dependence) was
associated with more regret in model 1 (β 10.1; 95% C.I. 3.2, 17.0). In model
2, palliative care consultation (3.0; 0.1, 5.9), limitations in life support
(LS) prior to death (6.3; 3.1, 9.4) and surrogate black race (6.3; 0.3, 12.3) were
associated with more regret. Other modulators of regret in subgroup analyses
included surrogate age and education level, surrogate-patient relationship,
death in hospital (compared to the post-discharge period), and code status at
time of ICU admission.
Conclusions
One in five ICU surrogate decision makers experience
moderate to strong regret about life support decisions in ICU. Poor patient
outcomes are linked to more regret. Decisions to limit life support prior to
patient death may also increase regret. Future studies are needed to understand
how regret relates to decision quality and how to lessen lasting regret.
