Decision-making in the ICU: perspectives of the substitute decision-maker

Intensive Care Med. 2003 Jan;29(1):75-82. doi: 10.1007/s00134-002-1569-y. Epub 2002 Nov 28.


Objective: To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making.

Design: Prospective, multicenter, cohort study.

Setting: Six Canadian university-affiliated ICUs.

Patients and participants: We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h.

Intervention: None.

Measurements and results: A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites.

Conclusions: In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Canada
  • Consumer Behavior*
  • Decision Making*
  • Family*
  • Female
  • Humans
  • Intensive Care Units*
  • Life Support Care*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Professional-Family Relations*
  • Prospective Studies