Evidence map›Paper›PMID 42441325›Full record

ArticleCHEST critical care2026

Black Surrogate Decision-Makers' Perspectives on the American Thoracic Society and Society for Critical Care Medicine Statement on Shared Decision-Making in ICUs.

Julia A Bulova, Kimberly Rak, Karen Bullock, Deborah Ejem, Rachel Butler, William C Gautier, Zi Chun Yang, Grace Vincent, Monica Cristina Leon Cadavid, Amy Houtrow and 3 more

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Article in CHEST critical care, 2026. 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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1 · What the graph read from it

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5 · Who and what money

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13 authors.

Julia A BulovaFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Kimberly RakFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Karen BullockFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Deborah EjemFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Rachel ButlerFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
William C GautierFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Zi Chun YangFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Grace VincentFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Monica Cristina Leon CadavidFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Amy HoutrowFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Yael SchenkerFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Kimberly JohnsonFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.
Douglas B WhiteFrom the University of Pittsburgh School of Medicine (J. B. and M. C. L. C.), the Department of Critical Care Medicine (K. R., R. B., Z. C. Y., G. V., and D. B. W.), the Department of Emergency Medicine (W. C. G.), the Department of Physical Medicine and Rehabilitation (A. H.), the Department of Medicine (Y. S.), University of Pittsburgh, Pittsburgh, PA; the School of Social Work (K. B.), Boston College, Boston, MA; the School of Nursing (D. E.), University of Alabama at Birmingham, Birmingham, AL; and the Department of Medicine (K. J.), Duke University, Durham, NC.

Funding

Randomized Trial of Specialty Palliative Care Integrated with Critical Care for Critically Ill Older Adults at High Risk of Death or Severe DisabilityR01AG068567 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SCHENKER, YAEL, WHITE, DOUGLAS B · 2020 to 2024
$3.4M
Mentored Patient Oriented Research in Improving Surrogate Decision Making for Patients with Advanced Respiratory FailureK24HL148314 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI Douglas B White · 2019 to 2026
$944k
Midcareer Investigator Award in Patient-Oriented Research: Yael Schenker, MD, MASK24AG070285 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SCHENKER, YAEL · 2021 to 2025
$841k
NHLBI NIH HHS K24 HL148314NIA NIH HHS K24 AG070285NIA NIH HHS R01 AG068567
6 · The paper itself

Abstract

backgroundThe American Thoracic Society (ATS) and the Society for Critical Care Medicine (SCCM) published a policy statement recommending communication skills to improve how clinicians support surrogate decision-makers in the ICU that was based on expert opinion and did not include patient or family input. RESEARCH QUESTION: What are the perspectives of Black individuals with prior experience as a decision-maker on the ATS and SCCM statement on shared decision-making in ICUs? STUDY DESIGN AND

methodsWe convened focus groups with Black individuals who have been surrogate decision-makers in the inpatient or ICU setting. Race-concordant, PhD-trained facilitators conducted the groups, which explored participants' prior experiences as surrogates, then presented a summary of the ATS and SCCM policy statement to elicit their opinions. We developed a codebook using an inductive thematic analysis approach, then double-coded interviews and resolved discrepancies by consensus.

resultsWe conducted 3 focus groups via Zoom (Zoom Video Communications Inc) with 20 participants. Participants described negative experiences communicating with doctors, attributed to racial biases and deficiencies in clinicians' communication skills. Participants generally endorsed the recommendations, including the focus not only on decision support skills, but also on relationship building and emotional support. They offered numerous suggestions for improvement, including (1) broadening the recommendations to apply to the interprofessional clinical team, (2) being receptive and responsive to the communication priorities of families, (3) allowing family more time and space to process information and emotions, (4) presenting all medically reasonable treatment options, (5) centering the family's concept of patient values, rather than the clinicians', and (6) including the entire family in decision-making, if preferred.

interpretationOur results show that participants endorsed the main recommendations in the ATS and SCCM policy statement on shared decision-making in ICUs and highlighted numerous areas for refinement. Participants' perspectives should inform future recommendations to provide more equitable care to Black patients and their families.

Indexed as

communicationcritical carecritical illnessend-of-life carehealth care disparities

Identifiers

PMID42441325
PMCPMC13336322

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.