Dilemmas in decision-making:a qualitative study of family surrogate decision-makers of severe stroke patients
10.3761/j.issn.0254-1769.2024.14.012
- VernacularTitle:重症脑卒中患者家属代理决策困境的质性研究
- Author:
Zining GUO
1
;
Keyu LING
;
Shufan CHEN
;
Haihan LI
;
Ting YAO
;
Sining ZENG
;
Ling XU
;
Xiaoping ZHU
Author Information
1. 230012 合肥市 安徽中医药大学护理学院
- Keywords:
Severe Stroke Patients;
Family;
Surrogate Decision-Making;
Dilemmas in Decision-Making;
Nursing Care;
Qualitative Research
- From:
Chinese Journal of Nursing
2024;59(14):1746-1751
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the dilemmas faced by surrogate decision-makers of severe stroke patients in treatment decision-making,and to provide a basis for developing decision support strategies.Methods From April to December 2023,through phenomenological qualitative research with 16 surrogate decision-makers with severe stroke patients from ICU of the department of neurology in a tertiary hospital in Jing'an District,Shanghai.semi-structured in-depth interviews were used to examine the perceptions of decision-making on surrogate.Data were analyzed via Braun's style of thematic analysis.Results 4 themes and 10 sub-themes were identified.Theme 1:negative emotional dilemmas(urgent decision-making leads to anxiety,fear,and unknown stroke trajectory increases the sense of uncertainty).Theme 2:supportive environment dilemmas(lack of information support delays decision-making;lack of family support increases decision-making stress;insufficient economic support increases the burden of decision-making).Theme 3:the dilemma of weighing the pros and cons(difficult trade-offs between risk and reward,tough decisions between reality and ethics,conflicting choices of life and dignity).Theme 4:preference management dilemmas(practical difficulties in adhering to patient preferences,impediments to decision-making due to unknown patient preferences).Conclusion Surrogate decision-makers of severe stroke patients face multiple decision-making dilemmas.Healthcare professionals should provide emotional support in multiple ways and comprehensive support to reduce the decision-making dilemmas experienced by surrogate decision-makers,as well as implement death education for surrogate decision-makers and promote advance care planning to reduce their decision-making stress.
