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Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit

Background: Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU)....

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Autores principales: Sun, Wan-Na, Hsu, Hsin-Tien, Ko, Nai-Ying, Huang, Yu-Tung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345805/
https://www.ncbi.nlm.nih.gov/pubmed/32575778
http://dx.doi.org/10.3390/ijerph17124443
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author Sun, Wan-Na
Hsu, Hsin-Tien
Ko, Nai-Ying
Huang, Yu-Tung
author_facet Sun, Wan-Na
Hsu, Hsin-Tien
Ko, Nai-Ying
Huang, Yu-Tung
author_sort Sun, Wan-Na
collection PubMed
description Background: Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU). This qualitative study surveyed a purposive sample of surrogates (n = 8; average age, 48 years) of cancer patients in the ICU of a medical center in Taiwan. A phenomenological methodology was used, and a purposive sample of surrogates of cancer patients were recruited and interviewed during the first three days of the ICU stay. Results: Based on the interview results, four themes were generalized through text progression: (1) Use love to resist: internal angst. This theme was related to the reflexive self -blame, the feelings of inner conflict, and the reluctance to make healthcare decisions, which surrogates experienced when they perceived suffering by the patient. (2) Allow an angel to spread love among us: memories and emotional entanglements. Memories of the patient caused the surrogate to experience emotional entanglements ranging from happiness to sadness and from cheerfulness to anger. (3) Dilemmas of love: anxiety about ICU visitor restrictions. The confined space and restricted visiting hours of the ICU limited the ability of surrogates to provide emotional support and to share their emotions with the patient. (4) Suffocating love: entanglement in decision-making. Emotional entanglements among family members with different opinions on medical care and their struggles to influence decision-making often prevented surrogates from thinking logically. Conclusions: Expression of emotions by ICU surrogates is often restrained and implicit, particularly in Asian populations. These results can help health professionals understand the psychological shock and inner conflict experienced by surrogates and provide a useful reference for improving their communications with surrogates.
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spelling pubmed-73458052020-07-09 Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit Sun, Wan-Na Hsu, Hsin-Tien Ko, Nai-Ying Huang, Yu-Tung Int J Environ Res Public Health Article Background: Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU). This qualitative study surveyed a purposive sample of surrogates (n = 8; average age, 48 years) of cancer patients in the ICU of a medical center in Taiwan. A phenomenological methodology was used, and a purposive sample of surrogates of cancer patients were recruited and interviewed during the first three days of the ICU stay. Results: Based on the interview results, four themes were generalized through text progression: (1) Use love to resist: internal angst. This theme was related to the reflexive self -blame, the feelings of inner conflict, and the reluctance to make healthcare decisions, which surrogates experienced when they perceived suffering by the patient. (2) Allow an angel to spread love among us: memories and emotional entanglements. Memories of the patient caused the surrogate to experience emotional entanglements ranging from happiness to sadness and from cheerfulness to anger. (3) Dilemmas of love: anxiety about ICU visitor restrictions. The confined space and restricted visiting hours of the ICU limited the ability of surrogates to provide emotional support and to share their emotions with the patient. (4) Suffocating love: entanglement in decision-making. Emotional entanglements among family members with different opinions on medical care and their struggles to influence decision-making often prevented surrogates from thinking logically. Conclusions: Expression of emotions by ICU surrogates is often restrained and implicit, particularly in Asian populations. These results can help health professionals understand the psychological shock and inner conflict experienced by surrogates and provide a useful reference for improving their communications with surrogates. MDPI 2020-06-20 2020-06 /pmc/articles/PMC7345805/ /pubmed/32575778 http://dx.doi.org/10.3390/ijerph17124443 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sun, Wan-Na
Hsu, Hsin-Tien
Ko, Nai-Ying
Huang, Yu-Tung
Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title_full Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title_fullStr Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title_full_unstemmed Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title_short Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
title_sort decision-making processes in surrogates of cancer patients in a taiwan intensive care unit
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345805/
https://www.ncbi.nlm.nih.gov/pubmed/32575778
http://dx.doi.org/10.3390/ijerph17124443
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