1. Wan-Na Sun1, Nai-Ying Ko22, Hsin-Tien Hsu3*
Determinates Of Decision-Conflict Among Health Care Proxy Of Lung Cancer Patients In Intensive Care Unit
Wan-Na Sun1, Nai-Ying Ko22, Hsin-Tien Hsu3*
BSN, RN, Nurse, National Cheng Kung University Hospital, Tainan, Taiwan 1, PhD, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Associate Director, Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan2, Associate Professor, School of Nursing, Kaohsiung Medical University; Deputy Director, Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung , Taiwan3*
Background
Results
Patients with lung cancer admitted feel very difficult to express their choices related to treatment because of the severity of their disease. They require the help of their surrogates in making medical decisions. Because of the high mortality rate and uncertain situations in the ICU, surrogates are frequently subject to conflicts while making medical decisions.
Data collected from 37 medical surrogates (mean age: 48.4 ± 12 years) of patients with lung cancer are reported(table 1). Overall, the mean of parental stress score was high (82.2±21.2). The mean of family support scores (36.8±10.3) was higher than those from medical team( 29.7±10.7). Decision conflicts were significantly correlated with personal income(r=-0.39, p=0.018), and medical team support(r=-0.6, p<0.001)(table 2).
Purpose
This study is explore the determinates of decision conflicts among surrogates of patients with lung cancer admitted in the ICU.
Table 1. Sample characteristics of surrogates
Variable N %
Age(year), mean(SD)
48.4 (±12)
Relationship to patient
spouse 12
32.4
children
parent 9
24.3
Other of relative 4
10.8
Gender
female 24 65
male 13 35
Marital status
married 31 84
single 6 16
Education
less than high school 22 60
University 15 40
Income(month)
less than 2,0000NT
35.1
more than 2,0001NT 25
64.9
Methods
A prospective, predictive design, and standardized instruments are applied in this study to examine the correlations between predictors and decision conflicts. Subjects aged 20 years or older are recruited based on the following inclusion criteria: surrogates of the patients who were diagnosed with lung cancer and collected from surrogates within 3 days of the patients’ admission in the ICUs. Data is collected by the demographic characteristic scale, the stress scale (parental stress scale, PSS), the interpersonal support evaluation scale(medical team and family support), and the decisional conflict scale. The relationships between predictors and decision conflicts were evaluated using correlation analysis and a multiple regression equation.
Table 2-2 The relationships between variables and decisional conflict
Variable
Correlation
P value
Age
0.31
0.070
Education
-0.02
0.930
Income
-0.39
0.018
parental stress
0.23
0.180
family support
-0.30
0.067
medical team
-0.60
<0.001
Table 2-1. The difference of those variables in decision conflict
Variable
t/F value
P value
Relationship to patient(spouse V.S children V.S parent V.S other of relative)
1.50
0.218
Gender(female V.S male)
-0.56
0.580
Marital status(married V.S single)
1.42
0.163
Conclusions/Implications for Practice
Data collection is ongoing. The results may help medical personnel have a full-frame understanding of decision conflicts and provide management strategies to surrogates to improve the quality of care for patients with lung cancer admitted in the ICU.