Abstract
SESSION TITLE: Palliative Care and End-of-Life SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: At the end of life, most decision making for critically ill patients is done by surrogates. We assessed health literacy among surrogates and assessed its relationship with psychological morbidity. METHODS: We performed an observational, cross-sectional single-center pilot study assessing the health literacy and psychological distress of surrogates faced with end-of-life decisions. Surrogates from patients in medical, surgical, cardiac, cardiothoracic surgical, and neurologic intensive care units were approached within one week of discussion with the critical care team regarding cardiopulmonary resuscitation, intubation, or tracheostomy placement. Participants completed a questionnaire collecting demographic information and validated instruments assessing health literacy (METER, s-NUMi, HLSI-5, and BHLS), decisional conflict regarding an end-of-life decision (DCS), and symptoms of depression and anxiety (HADS), and post-traumatic stress (IES-R). RESULTS: Twenty-one surrogate decision makers completed the questionnaire. The median age was 55 (IQR 49-63); 71% were female. Fifty-two percent identified as African American, 48% as Caucasian. Fifty-two percent reported prior experience as a surrogate. The median patient APACHE-II score was 21 (IQR 17-24). The median Charlson Comorbidity Index was 4 (IQR 2-6). Overall, participants demonstrated average or above average objective health literacy but self-perceived health literacy was marginal. Surrogates scored low for decisional conflict. Median scores for anxiety (HADS-A subscore 9, IQR 7-14), depression (HADS-D subscore 8, IQR 5-10), and post-traumatic stress (IES-R score 28, IQR 22-38) suggested increased symptom burden in the study group. Compared with the overall group, the 5 participants who scored 0 for decisional conflict reported less post-traumatic stress symptom burden (IES-R score 21, IQR 19-24), while having similar health literacy, anxiety and depression scores. Compared with the overall group, the 6 participants scoring 17 or higher for decisional conflict showed a greater burden of anxiety (HADS-A subscore 13, IQR 8-14) and post-traumatic stress symptoms (IES-R score of 31, IQR 28-37). CONCLUSIONS: Among surrogates, we found average or better-than-average levels of health literacy, low decisional conflict regarding life-sustaining treatment questions, and high psychological symptom burden. Higher decisional conflict was associated with greater anxiety and post-traumatic stress symptom burden, despite similar health literacy. CLINICAL IMPLICATIONS: Psychological distress may be associated with greater decisional conflict regarding end-of-life decisions for surrogate decision makers of critically ill patients. Further research is needed to determine the association between health literacy, psychological distress and decisional conflict. DISCLOSURES: No relevant relationships by William Grier, source=Web Response No relevant relationships by Melissa Motta, source=Web Response No relevant relationships by Giora Netzer, source=Web Response No relevant relationships by Sara Viola, source=Web Response
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