The concept of a surrogate is ill adapted to intensive care: Criteria for recognizing a reference person

Abstract

Purpose: In the intensive care unit (ICU), caregivers may find it difficult to identify a suitable person in the patient's entourage to serve as a reference when there is no official surrogate.

Methods: We developed a 12-item questionnaire to identify factors potentially important for caregivers when identifying a reference person. Each criterion was evaluated as regards its importance for the role of reference. Responses were on a scale of 0 (not important) to 10 (extremely important). We recorded respondent's age, job title, and number of years' ICU experience. The questionnaire was distributed to all health care professionals in 2 French ICUs.

Results: Among 144 staff, 128 were contacted; 99 completed the questionnaire (77% response rate; 20 physicians [11 residents], 51 nurses, 28 nurse's aides). Items classed as most important attributes for a reference person were knowledge of patient's wishes and values, emotional attachment, adequate understanding of the clinical history, and designation as a surrogate before admission. There were no significant differences according to respondent's age, job title, or experience.

Conclusion: Caregivers identify a reference person based on criteria such as knowledge of the patient's wishes, emotional bond with the patient, an adequate understanding of the clinical history, and designation as surrogate before admission.

Keywords: Ethics; Intensive care; Questionnaire; Surrogate.