Anticipatory grief and impaired problem solving among surrogate decision makers of critically ill patients: A cross-sectional study

Glick, D.R.; Motta, Melissa; Wiegand, Debra L.; Range, Patrick; Reed, Robert M.; Verceles, Avelino C.; Shah, Nirav G.; Netzer, Giora

doi:10.1016/j.iccn.2018.07.006

Cited by 15 publications

(11 citation statements)

References 28 publications

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“…The AGS is a 27-item measure of anticipatory grief scored on a 5-point Likert scale. Scores range from 5 to 135, with higher scores being indicative of higher levels of anticipatory grief [21]. The scale has been applied to populations of patient guardians, and caregivers of patients with dementia or cancer, and it typically takes approximately 10-15 min to complete [11,22].…”

Section: Anticipatory Grief Scale (Ags)mentioning

confidence: 99%

The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study

Sun

Zhang

et al. 2022

BMC Palliat Care

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Background Anticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. Qualitative study suggests that illness uncertainty may be one of the core characteristics of anticipatory grief, but it has not been confirmed in quantitative studies. Therefore, the purpose of this study was to explore the relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer and to determine the factors influencing anticipatory grief. Methods This descriptive cross-sectional study used a convenience sampling method and recruited 254 inpatient family caregivers from the thoracic medicine ward of Liaoning Cancer Hospital & Institute in Shenyang, mainland China. Anticipatory grief (Anticipatory Grief Scale (AGS), illness uncertainty (Uncertainty in Illness Scale Family Caregiver Version) and sociodemographic information (Self-compiled general information questionnaire) were measured using validated self-report measures. Results Chinese family caregivers of patients with advanced lung cancer had high levels of anticipatory grief (73.5 ± 16.1). The results of the correlation analysis showed a positive association between anticipatory grief and illness uncertainty (r = 0.580, P < 0.001). The final linear regression model with anticipatory grief as the dependent variable included four variables: illness uncertainty (β = 0.674, P < 0.001), lack of informativeness (β = − 0.168, P = 0.08), monthly income (β = 0.139, P = 0.006), and caregiving burden (β = − 0.196, P < 0.001). Conclusions Illness uncertainty is probably an important factor affecting anticipatory grief. Excessive caregiving burden is associated with high levels of anticipatory grief. Improving illness uncertainty and caregiving burden may effectively reduce anticipatory grief among Chinese family caregivers.

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Section: Anticipatory Grief Scale (Ags)mentioning

confidence: 99%

The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study

Sun

Zhang

et al. 2022

BMC Palliat Care

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“…This meant that participants were unlikely to be experiencing the psychiatric stressors common among ICU surrogates, such as anxiety, depression, and sleep deprivation, and the associated cognitive blunting. 17,18,20 The persistence of optimistic difference in belief in our study population suggests that surrogate optimism may exist before a person who is chronically ill arrives in the ICU and is not primarily attributable to the stress of acting as a surrogate for a family member who is acutely ill.…”

Section: Discussionmentioning

confidence: 84%

“…12,15,16 Previous research on communicating prognosis has enrolled people actively acting as surrogates in ICU settings. Anxiety, depression, sleep deprivation, anticipatory grief, and posttraumatic stress are common in this population [17][18][19][20] and likely affect how they interpret prognostic information. 17,20,21 We hypothesize that the complex language used by intensivists and the acute stress and exhaustion of being a surrogate in an ICU setting contribute to surrogate misunderstandings.…”

Section: + Visual Abstract + Video + Supplemental Content Introductionmentioning

confidence: 99%

“…Anxiety, depression, sleep deprivation, anticipatory grief, and posttraumatic stress are common in this population [17][18][19][20] and likely affect how they interpret prognostic information. 17,20,21 We hypothesize that the complex language used by intensivists and the acute stress and exhaustion of being a surrogate in an ICU setting contribute to surrogate misunderstandings. If this hypothesis is correct, direct communication about prognosis using simple language has the potential to minimize misunderstandings and reduce discordant surrogate optimism.…”

Section: + Visual Abstract + Video + Supplemental Content Introductionmentioning

confidence: 99%

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Effect of Intensivist Communication in a Simulated Setting on Interpretation of Prognosis Among Family Members of Patients at High Risk of Intensive Care Unit Admission

et al. 2020

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IMPORTANCE Discordance about prognosis between a patient's health care decision-making surrogate and the treating intensivist is common in the intensive care unit (ICU). Empowering families, friends, and caregivers of patients who are critically ill to make informed decisions about care is important, but it is unclear how best to communicate prognostic information to surrogates when a patient is expected to die. OBJECTIVETo determine whether family members, who are often health care decision-making surrogates, interpret intensivists as being more optimistic when questions about prognosis in the ICU are answered indirectly. DESIGN, SETTING, AND PARTICIPANTSThis web-based randomized trial was conducted between September 27, 2019, and October 17, 2019, among a national sample of adult children, spouses, partners, or siblings of people with chronic obstructive pulmonary disease who were receiving longterm oxygen therapy. Participants were shown video vignettes depicting an intensivist answering a standardized question about the prognosis of a patient at high risk of death on day 3 of ICU admission. Participants were excluded if they had worked as a physician, nurse, or advanced health care practitioner. Data were analyzed from INTERVENTIONS Participants were randomized to view 1 of 4 intensivist communication styles in response to the question "What do you think is most likely to happen?": (1) a direct response (control), (2) an indirect response comparing the patient's condition with that of other patients, (3) an indirect response describing the patient's deteriorating physiological condition, or (4) redirection to a discussion of the patient's values and goals. MAIN OUTCOMES AND MEASURES Participant responses to 2 questions: (1) "If you had to guess,what do you think the doctor thinks is the chance that your loved one will survive this hospitalization?" and (2) "What do you think are the chances that your loved one will survive this hospitalization?" answered using a 0% to 100% probability scale. RESULTSAmong 302 participants (median [interquartile range] age, 49 [38-59] years; 204 [68%]women) included in the trial, 165 (55%) were adult children of the individual with chronic obstructive pulmonary disease; 77 participants were randomized to view a direct response, 77 participants were randomized to view an indirect response referencing other patients, 68 participants were randomized to view an indirect response referencing physiological condition, and 80 participants were randomized to view a redirection response. Compared with participants who viewed a direct response, participants who viewed an indirect response referencing other patients (β = 10 [95% CI, (continued) Key Points Question Do intensivist communication patterns affect the way family members understand their loved one's prognosis in the intensive care unit?Abstract (continued) 1-19]; P = .03), physiological condition (β = 10 [95% CI, 0-19]; P = .04), or redirection to a discussion of the patient's values and goals (β = 19 [95% CI, 10-28]; P < .001) p...

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“…Our conceptual model posits that symptoms of grief, anxiety, traumatic stress, and related maladaptive coping reactions such as dissociation and avoidance, interfere with engaging in value-concordant and empowered end-of-life decision-making (Glick et al, 2018). We highlight the role in coping of experiential avoidance, which is the natural tendency to avoid unpleasant feelings and consideration of negative outcomes (Gamez et al, 2014;Gamez et al, 2011;Plumb et al, 2004) and which has been associated with PTSD and PGD (Bishop et al, 2018;Marx & Sloan, 2005a;Serrano-Ibanez et al, 2021;Williams et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

et al. 2021

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Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

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Anticipatory grief and impaired problem solving among surrogate decision makers of critically ill patients: A cross-sectional study

Cited by 15 publications

References 28 publications

The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study

The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study

Effect of Intensivist Communication in a Simulated Setting on Interpretation of Prognosis Among Family Members of Patients at High Risk of Intensive Care Unit Admission

Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

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