Abstract 288: The Tool to Empower (TEMPO) Surrogate Decision Makers of Comatose Survivors of Cardiac Arrest: A Pilot Trial of a Novel Decision Tool

Abstract

Introduction: OHCA is a sudden unexpected event that frequently renders patients incapable of decision-making. Surrogate decision makers are often thrust into the position of deciphering complex medical information while representing their loved one’s wishes with little support. Hypothesis: An evidence based, iteratively designed decision tool will be feasible to deploy, acceptable to surrogates, increase knowledge of post-cardiac arrest care and impart self-efficacy for decision making. Goal: To measure the efficacy of a novel decision aid for surrogates. Methods: We conducted a pilot trial of the T ool to EMPO wer (TEMPO) decision makers to examine feasibility, acceptability, knowledge, and self-efficacy. Surrogates were given a pre-intervention survey on the day of arrest, provided the tool and a post-intervention survey at least 24 hours later. The survey included an 8-question knowledge questionnaire. The post-interventions survey included the same knowledge questions, the Ottawa acceptability survey and a measure of self-efficacy for decision-making for the unconscious patient. Results: We enrolled 41 surrogates into the TEMPO Pilot Trial between 9/20 and 12/22. Subjects identified were predominantly women (75.6%, n=31), 53.7% were White, 22% Black and 24.4% Hispanic. Participants had varied relationships to the patient including spouse (44%), sibling (17%), adult child (17%) and parent (12%). Knowledge increased from 56.4% to 85.9%, an absolute improvement of 29.5%. Significant improvements were noted in self-efficacy in the following domains after exposure to TEMPO: 1) receipt of resuscitation; 2) care at the end-of-life; and 3) continued desire to fight the disease. Surrogates found the tool to be useful (84.6%) and that it made their choice easier (91.2%). One participant reported “I had never dealt with this and did not know what to expect so the information given was very helpful” and another stated “Now I know what type of questions to ask and what to look for.” Conclusion(s): In a pilot trial of TEMPO, a novel decision tool for surrogate decision makers of comatose survivors of cardiac arrest, we found the intervention was feasible, acceptable, improved knowledge and increased feelings of self-efficacy in decision making.