ArticleCHEST critical care2024
Predictors of Medical Mistrust Among Surrogate Decision-Makers of Patients in the ICU at High Risk of Death: A Pilot Study.
Article in CHEST critical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMedical mistrust may worsen communication between ICU surrogate decision-makers and intensivists. The prevalence of and risk factors for medical mistrust among surrogate decision-makers are not known. RESEARCH QUESTION: What are the potential sociodemographic risk factors for high medical mistrust among surrogate decision-makers of critically ill patients at high risk of death? STUDY DESIGN AND
methodsIn this pilot cross-sectional study conducted at a single academic medical center between August 2022 and August 2023, adult patients admitted to the medical ICU and their surrogate decision-makers were enrolled. All patients were incapacitated at enrollment with Sequential Organ Failure Assessment scores of ≥ 7 or required mechanical ventilation with vasopressor infusion. Surrogate decision-maker sociodemographic characteristics were age, race, sex, education, relationship to the patient, employment, prior exposure to a loved one transitioning to hospice or comfort-focused care, and religiousness. The primary outcome was surrogate decision-maker medical mistrust, measured using the Medical Mistrust Multiformat Scale. Multiple linear regression was used to determine sociodemographic characteristics associated with higher medical mistrust.
resultsThirty-one patients and their surrogate decision-makers were enrolled during the study period, surpassing our goal of 30 pairs and indicating recruitment feasibility. Mean ± SD surrogate age was 53.8 ± 14.5 years, 24 surrogates were female, and mean medical mistrust score was 17.1 ± 5.4. Race was associated with medical mistrust, with Black participants showing higher medical mistrust compared with White participants (β =10.21; 95% CI, 3.40-17.02;
interpretationWe found that recruiting ICU surrogates and measuring medical mistrust within 48 h of ICU admission was feasible. Several surrogate sociodemographic characteristics were associated with changes in medical mistrust. These preliminary findings will inform the design of future studies.
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