Typologies of Decision-Makers in the ICU: A Qualitative Study of Patients With Acute Respiratory Distress Syndrome and Sepsis and Their Surrogates

To develop hypotheses of patient and surrogate's rationale for decision-making.

Design: We pursued a qualitative study of patients with acute respiratory distress syndrome or sepsis and their surrogates. Fourteen patients and 28 surrogates were given semistructured interviews while in the ICU and again 30 days later. The interviews focused on goal outcomes for the ICU stay and why a patient or surrogate would want a specific intervention (e.g., intubation and cardiopulmonary resuscitation).

Setting: ICU of tertiary care academic hospital.

Patients: Fourteen acute respiratory distress syndrome or sepsis patients and 28 of their surrogates.

Interventions: None.

Measurements and main results: Interviews were analyzed using grounded theory and the constant comparative method on NVivo 10.0 (QSR International, Melbourne, Australia). We identified the following four typologies of decision-making rationale: 1) "Timers"-determined decisions based on the length of time on life support; 2) "Natural Livers"-rejected interventions using a "machine"; 3) "Deferrers"-relied on physician for decision-making and prognosis; and 4) "Believers"-relied on a higher power for guidance.

Conclusions: Our hypothesized typologies need validation in a prospective observational trial. If validated, they may allow for better clinician communication.