What can clinicians do to help surrogates
with the decision-making process?
First and foremost thing is they have
to establish and maintain trust.
They have to be trustworthy in how
they're communicating with the surrogate.
So, there's a certain amount of
reciprocity in that relationship.
So, the give and take of communication, you're
as a clinical, sharing information with the surrogate.
You want to get information back from them.
You want to show that it's a trustworthy process
that you're going to really rely on them to speak
on the best interest of the patient.
If you've made any particular treatment plans,
if there's been any kind of negotiation in figuring out,
you know, shared decision-making of what
you're going to do, that you keep those agreements,
you follow through on the plan that you've
arranged with the surrogate decision maker.
If it's difficult information similar to what we do
with patients in breaking serious or difficult news,
we're going to share information with the
surrogate decision maker honestly attending
to their emotions, making sure they really
are able to handle that information.
Whenever we speak with
surrogate decisions makers,
we should make sure we're going in with the
proper intention that we speak with good purpose.
We take the seriousness of the situation
and we, you know, really help
that surrogate decision maker with their decision-making.
And always, we should be showing respect for that person.
It's a difficult situation to be in, so, we show
them respect in our communication with them,
again, to make sure we're establishing
and maintaining trust with them.
We need to meet their emotional needs.
You know, they're going to be seeing their loved ones sick.
They're going to have
emotional reactions to that.
So, we have to provide the empathetic
response to what they're going through.
They may have spiritual needs as well
that we also have to attend to, either ourselves
as the clinicians or inviting other members
of the healthcare team, a chaplain or other,
you know, faith or spiritual adviser to help
with the surrogate's spiritual needs
as they're serving this role as a decision maker.
And lastly, it's, you know, an ongoing process.
So, we want to help them be confident in their role
as a surrogate decision maker.
We want to build their self-efficacy
for being a decision maker.
So, that's also talking to them about
what to expect, what decisions they might need
to make in the future, knowing what their role is,
what they need to do, you know, do you need to go home
and talk to other family members
and weigh the information we've given you
and then, come back tomorrow
and we'll make a decision?
They need to sort of have clear expectations
of what their role requires.
When you have actual meetings
with surrogate decision makers,
there are a few steps that
you should keep in mind.
You should first of all just say, this is something
that we do with all family members
when a patient can't make their own decisions.
You want to normalize the process.
It's, you know, common for us to meet
with family to help them think through the issues
and come up with decisions
for their loved one.
You want to acknowledge that it's difficult
to be a surrogate decision maker.
You know, it' hard for you
to be put in this role.
We know it's, you know, sometimes requires
some interpretation of the patient's previous wishes
or what they've put in advanced
directive, acknowledge that difficulty
and say, again, tryng to do the best you can,
so, we can serve the patient's best interest.
You want to show compassion for the
surrogate in seeing their loved one ill.
So, helping them cope with what's going on,
coping with the situation.
For instance, in the intensive care unit,
we often see family members
who are distraught or very anxious.
They don't sleep.
They stay in the hospital all the time.
We need to make sure that they are taken care of themselves,
so, that they can then, you know, be the
surrogate decision maker for their loved one.
You want to put the decision-making
process in the context of a team.
So, you want to say, "We're the team helping
you make decisions but you're also a team member.
We're all trying to do this together
on behalf of the patient."
So, making sure that they're aware that they've got
that support of the rest of the team in this context.
And then, again, the whole goal of this is we really
want to try to understand the patient's previously
expressed values, goals, beliefs, who they
were as a person, who they are as a person.
And then, let the surrogate make decisions,
give them the recommendations,
but then, make the decisions based
on their knowledge of the patient.