Faith in Crisis: A Qualitative Analysis of Surrogate Decision Makers' Faith Commitments in Withdrawal-of-Care Decisions and ICU Provider Responses in Neurocritical Care
Bryan Strelow, BS, Fellow of Theology, Medicine and Culture, Duke Divinity School
For patients and their loved ones, hospitals are often places of intense emotional and spiritual strife. The Neurocritical Care Unit, alike to many intensive care units, is certainly one such place. As such, this crucible can be seminal in testing and shaping the moral and spiritual frameworks for a patient’s family and especially their surrogate decision makers. In this setting, “goals of care” conversations between ICU teams and family members, those who are wrestling with the dire health of their loved ones and simultaneously trying absorb technical information about prognosis and quality of life projections, can be critical moments, indeed often crisis moments, for the practice of deeply held beliefs about life and death, about divinity and humanity. This study will investigate how families and healthcare teams respond to these situations. Specifically, we interrogate how surrogate decision makers’ faith commitments impact the decision of whether or not to withdraw care from Neuro-ICU patients.
This study is a retrospective qualitative analysis conducted through interviews with surrogates who were involved in decisions to execute “terminal extubations” of their loved ones. Participants will be selected the UNC Neuroscience Intensive Care Unit database of “terminal extubation” surrogate decision makers. Interviews of surrogates will be conducted several months after the death of NSICU patients, and will be a structured interview which encourages reflection about the impact of faith commitments on the decision to withdraw care, and how this event has shaped the surrogate’s current understanding of end of life decision making. Additionally, interviews with NSICU team members involved in goals of care discussions will probe healthcare providers’ opinions and beliefs about these decisions.
A qualitative analysis of interviewee’s responses will help to answer the following key questions:
1) In what ways do a surrogate’s faith commitments impact the decision to withdraw care in patients with devastating neurological injuries?
2) In what ways does the decision to withdraw care from a loved one impact surrogate decision makers’ prior faith commitments?
3) How do surrogates’ decisions impact personal wishes about their own end of life care?
4) In what ways do ICU healthcare providers currently understand surrogates’ decisions to withdraw care in patients with devastating neurological injury?
5) Can an understanding of surrogates’ faith commitments better equip ICU providers to uphold benevolence and to support patient autonomy in the context of withdrawal-of-care decisions?
6) Can an understanding of surrogates’ faith commitments offer ICU providers a better vocabulary with which to engage next of kin during withdrawal-of-care discussions?
For patients and their loved ones, hospitals are often places of intense emotional and spiritual strife. The Neurocritical Care Unit, alike to many intensive care units, is certainly one such place. As such, this crucible can be seminal in testing and shaping the moral and spiritual frameworks for a patient’s family and especially their surrogate decision makers. In this setting, “goals of care” conversations between ICU teams and family members, those who are wrestling with the dire health of their loved ones and simultaneously trying absorb technical information about prognosis and quality of life projections, can be critical moments, indeed often crisis moments, for the practice of deeply held beliefs about life and death, about divinity and humanity. This study will investigate how families and healthcare teams respond to these situations. Specifically, we interrogate how surrogate decision makers’ faith commitments impact the decision of whether or not to withdraw care from Neuro-ICU patients.
This study is a retrospective qualitative analysis conducted through interviews with surrogates who were involved in decisions to execute “terminal extubations” of their loved ones. Participants will be selected the UNC Neuroscience Intensive Care Unit database of “terminal extubation” surrogate decision makers. Interviews of surrogates will be conducted several months after the death of NSICU patients, and will be a structured interview which encourages reflection about the impact of faith commitments on the decision to withdraw care, and how this event has shaped the surrogate’s current understanding of end of life decision making. Additionally, interviews with NSICU team members involved in goals of care discussions will probe healthcare providers’ opinions and beliefs about these decisions.
A qualitative analysis of interviewee’s responses will help to answer the following key questions:
1) In what ways do a surrogate’s faith commitments impact the decision to withdraw care in patients with devastating neurological injuries?
2) In what ways does the decision to withdraw care from a loved one impact surrogate decision makers’ prior faith commitments?
3) How do surrogates’ decisions impact personal wishes about their own end of life care?
4) In what ways do ICU healthcare providers currently understand surrogates’ decisions to withdraw care in patients with devastating neurological injury?
5) Can an understanding of surrogates’ faith commitments better equip ICU providers to uphold benevolence and to support patient autonomy in the context of withdrawal-of-care decisions?
6) Can an understanding of surrogates’ faith commitments offer ICU providers a better vocabulary with which to engage next of kin during withdrawal-of-care discussions?