The struggle continues: Improving outcomes for surrogate decision-makers after the ICU

The ICU setting presents myriad stressors for surrogate decision-makers of critically ill patients, including deficiencies in clinician communication and the emotional toll of surrogate decision-making. These stressors can contribute to patients receiving unwanted or nonbeneficial burdensome treatments and to surrogates’ long-term psychological outcomes. Approximately one in three ICU surrogates experiences significant and lasting emotional and psychological burdens, and this rate increases substantially when end-of-life decision-making or the death of a loved one occur. Unfortunately, improving this pervasive problem has proven a tough nut to crack.

Katherine R Courtright, James Downar