The struggle continues: Improving outcomes for surrogate decision-makers after the intensive care unit

The intensive care unit (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 1 in 3 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