Although surrogate trust in ICU physicians is an important factor in avoiding conflicts during end of life decision-making, a team of researchers has determined that nurses play a critical role in fostering trust between physicians and patient surrogates.

Seeking to better understand how the lack of confidence between surrogates and clinicians affects shared decision-making, the Northwestern University researchers, led by Paul J. Hutchison, M.D., conducted in-depth, semi-structured interviews with 30 surrogate decision-makers in a closed-model medical intensive care unit. The surrogates then answered questions about their overall ICU experiences and their level of trust in clinicians.

According to the transcribed interviews, surrogates prefer the care and relationships of ICU nurses to physicians. “The constant activity and focus of nurses in patient rooms strengthens trust and reassures surrogates that their loved ones will receive good care even at times when they are not present,” the submitted abstract read.

However, the reputation and name of the medical facility in which a patient is being treated also affected surrogates’ levels of trust in physicians.

A hospital with a more exclusive, higher-end image caused some surrogates to “blindly” trust their loved one’s care. According to Hutchison, patients and their surrogates even value “blunt and non-sugar-coated” talk with physicians, as long as they can still identify with the humanistic qualities of the doctor.

Their research was presented as a poster entitled “Dimensions and Mediators of Surrogate Trust in the Intensive Care Unit,” and displayed at the John and Gwen Smart Symposium at Northwestern University’s Buehler Center on Aging, Health and Society.

Hutchison and his team provided three recommendations for improving trust: (1) intensive care units should provide plenty of nursing and support staff; (2) physicians should mind their tone and style when communicating with surrogates and a patient’s loved ones; (3) interventions aimed at increasing trust should be role specific, because surrogate expectations are different for physicians and nurses.

“I think there is an incredible amount of stress with surrogates in the ICU. They are more anxious and want to contribute,” Hutchison said. “But clinicians often don’t appreciate their hardships or show enough sympathy.”

When asked what he would like his future patients and their surrogates to know, Hutchison replied: “I’d like them to know that we really have a genuine concern for their needs, but sometimes we need assistance. Tell us your needs as a decision-maker.”