Active Role In Decision Research Articles

Examining the role of youth empowerment in preventing adolescence obesity in low-income communities

IntroductionYouth empowerment programs have increasingly gained attention in public health as emphasis shifts on children and adolescents as decision makers in their health and well-being. Adolescence obesity is among the public health concerns that require more active engagement at individual and community level while empowering adolescents to take charge of their own health. This study examines the influence of youth empowerment on nutritional and physical activity factors associated with adolescence obesity. MethodsData were gathered through a self-administered survey among adolescents (N = 410) ages 11–15 years in three U.S. States - Kansas, Ohio and South Dakota. ResultsFindings show that youth empowerment significantly influences adolescents' self-efficacy, perceptions for healthy food choice, healthy eating, attitudes towards physical activity and the overall motivation for health. Gender differences exist in adolescents' self-efficacy for physical activity whereas ethnicity played a role in perceived youth empowerment and perceived barriers to healthy eating. Age was also a significant contributor in efficacy for healthy food choice and perception of healthy food availability. ConclusionsThis study suggests more focus on youth empowerment in interventions that seek to reduce obesity and improve adolescents' overall health by creating environments where they can play a more active decision-making role. With empowerment, adolescents are more likely to be motivated to adopt healthier dietary habits and engage more in physical activity. Further research would establish the impact of youth empowerment on obesity reduction and other public health problems that impact children across ages.

Afterword: Ethics as Impact—Moving From Error-Avoidance and Concept-Driven Models to a Future-Oriented Approach

Beginning with the premise that most regulatory guidelines for research ethics are deeply flawed, this article walks the reader through three models that can help social researchers, technologists, and designers identify and reflect on how they’re approaching ethics, or “doing the right thing” in their own work. The first, an error-avoidance model, has traditionally focused on creating frameworks to help researchers avoid repeating historical ethical violations. The second concept-driven model focuses on refining the concepts that undergird core ethical frameworks. Both are dominant in human-focused research and tend to be highly proceduralized, implemented a priori or from the top down as part of largescale regulatory structures. In both of these models, the agency of the researcher is removed or dismissed as less relevant than the agency of the system. The article draws on recent controversies around data collection and corporate experimentation on social media users as well as two academic research cases to illustrate how these two models fail repeatedly because they do not retain enough flexibility to allow for recontextualizing ethics as needed on a case-by-case basis. The third, an impact-model of ethics, offers an alternative whereby researchers, technologists, and designers can take a more active role in decisions about the contexts they study, by exploring the possible positive and negative impact of their work. This article invites us to work toward building a different balance in agential distribution in our models around responsible conduct of research, so that the conceptual and regulatory systems that guide and impede our actions are more balanced with our own agency as decision makers, with accountability and responsibility for doing the ‘right thing’.

Towards a more positive view of healthcare in Ireland.

Ireland has a population of just over one million children, the highest birth rate in the European Union, significant income inequalities and an increasing non-national population. Our under five mortality figures have shown a steady decline to 3.6 per 1000 and are amongst the best in the world. Examples of high-quality healthcare results include neonatal intensive care outcomes, paediatric cancer survival rates, surgical outcomes in congenital heart disease, improved survival in cystic fibrosis and renal transplantation results. Positivity alone is not enough and I propose a 10-point plan for future healthcare for children and young people. We should first and foremost aim for health not care and prevention plays a key role. Parents and families should play an active role in decisions around their children's health and should be aware of results of treatment. Care should be delivered as close to home as possible and we should strengthen both primary and community care and provide additional support to general practitioners to manage childhood illness closer to home. We need to plan for new morbidities such as type 1 diabetes, obesity, mental health issues and inflammatory bowel disease. General paediatrics is a key enabler of better healthcare for children. We should advocate for a future system focussed on quality, reducing geographical variation and supporting local care, thereby keeping children out of hospital as much as possible.

Role preferences of patients with alcohol use disorders

AimsShared decision making (SDM) is increasingly demanded in medical decision making. SDM acknowledges patients' role preferences in decision making processes. There has been limited research on SDM and role preferences in substance use disorders; results are promising. Aim of this study was to investigate role preferences of patients with alcohol use disorders (AUD), and to identify predictors of these preferences. MethodCross-sectional data collected from June 2013 to May 2014 in four detoxification wards in Germany during a randomised controlled trial (RCT, Registration Code 01GY1114) was analysed.Of the 250 patients with AUD who were included in the RCT, data from 242 patients [65% male; mean age = 45.2 years (sd = 10.3)] were analysed. Participants' role preferences were assessed with the Control Preference Scale. Potential correlates were drawn from instruments used in the RCT; multinomial logistic regression was used. Results90% (n = 217) of the AUD patients preferred an active or shared role in decision-making, 10% (n = 25) preferred a passive role. Patients' desire for help was associated with their role preference (OR = 3.087, p = .05). The model's goodness of fit was Nagelkerke's R2 = 0.153 [χ2 (24) = 25.206, p = .395]. ConclusionsPatients' preference for an active role in decision-making underscores the importance of involving patients in their treatment planning. Patients' desire for help seems to be an important determinant of paternalistic decision making. However, further research is needed to determine whether patients' role preferences are related to their behavior during their treatment referral and recovery.

Teaching Sustainability Leadership in Manufacturing: A Reflection on the Educational Benefits of the Board Game Factory Heroes

Sustainability is a complex and interdisciplinary topic which can be challenging to teach. We need to adopt a student-centred and participative approach to invite learners to reflect on societal challenges and their role as individuals to tackle them. Therefore, we need appropriate educational tools to encourage creativity, an open mind and broad thinking to raise awareness and teach about sustainability. Gamification and serious games have recently emerged as promising tools to engage students by immersing them in various complex situations and giving them an opportunity to play an active role in decision-making. Gamification lends itself particularly well to sustainability education as it provides a safe and fun environment for students to experiment, to take complex decisions and to reflect on the impact of their actions. It can deliver the necessary skills to address today's global challenges: envisioning, critical thinking and reflection, systemic thinking, collaboration and decision-making in uncertain conditions. This paper introduces a board game, Factory Heroes, and discusses its potential in raising awareness and fostering the skills and knowledge for sustainability leadership in manufacturing. Early findings from 8 pilot sessions are presented along with some of the benefits and pitfalls of gamification.

Emergency surgery and Limitation of therapeutic effort in relation to neurologic deterioration in elderly patients – a survey of European surgeons

Background. In emergency surgery, a very heterogeneous approach is required in the decision making process, especially when considering the patient’s postoperative quality of life as well as medical, ethical, and legal factors. In some cases, the presence of an Advance Directive (AD) form may potentially help resolve the surgeon’s dilemma. Objectives. The primary objective of this survey was to investigate the opinions of surgeons across a representative cross-section of European countries regarding the decision making process using a specific case scenario so as to identify similarities and differences in practice. A secondary objective was to identify the possibility of establishing a more uniform approach and best practice. Method. A survey was conducted of surgeons from a range of European countries. Questionnaires were designed to obtain an overview of decision making in relation to the Limitation of Therapeutic Effort (LTE) using a specific case study and the level of awareness and practical use of ADs. Surveys were distributed via email to the members of the ESTES (European Society for Trauma and Emergency Surgery) and AEC (Association of Spanish surgeons), with voluntary, anonymous participation. Conclusions. Clear and additional support in the form of legal and ethical guidance with clinical protocols for surgical practice in such case scenarios is necessary. Wider use of ADs, together with education about their role and support for patients and relatives, would benefit the type of patient described in our scenario. A multidisciplinary team should play a more active role in decision making in order to avoid surgical procedures that are potentially futile. The concepts of LTE and Quality of life need a broader understanding among surgeons as well as more consistent application.

Decision aids for people facing health treatment or screening decisions.

Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. To assess the effects of decision aids in people facing treatment or screening decisions. Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.

The Role of Psychological Empowerment and Organizational Citizenship Behaviors on Employee Resistance to Change

In today’s competitive business world, change is inevitable for organizations. During an organizational change, the toughest challenge of organizational leaders is to manage employee resistance to change. It is well established in literature that employee resistance is one of the leading causes for the failure of organizational change efforts. The purpose of this paper is to explore the impact of psychological empowerment and organizational citizenship behaviors on employee resistance to change. It also investigates if psychological empowerment can be used as a human resource management strategy during a planned change in order to increase commitment to change. The study took place in Turkey in a private company which went under a strategic organizational change recently. Survey collection from employees and interviews with two human resource managers were the main tools in collecting information. The results from 85 respondents showed that both psychological empowerment and organizational citizenship behaviors have significant negative influence on employee resistance to change. The interview results showed that through psychological empowerment, employees were more involved in change process, took active role in decision making and were more committed to the change. The implications of the study can be used by organizational change practitioners to maintain employees’ positive reactions to change by considering psychological empowerment and organizational citizenship behaviors as a tool to lower the level of resistance.

The Role of Psychological Empowerment and Organizational Citizenship Behaviors on Employee Resistance to Change

In today’s competitive business world, change is inevitable for organizations. During an organizational change, the toughest challenge of organizational leaders is to manage employee resistance to change. It is well established in literature that employee resistance is one of the leading causes for the failure of organizational change efforts. The purpose of this paper is to explore the impact of psychological empowerment and organizational citizenship behaviors on employee resistance to change. It also investigates if psychological empowerment can be used as a human resource management strategy during a planned change in order to increase commitment to change. The study took place in Turkey in a private company which went under a strategic organizational change recently. Survey collection from employees and interviews with two human resource managers were the main tools in collecting information. The results from 85 respondents showed that both psychological empowerment and organizational citizenship behaviors have significant negative influence on employee resistance to change. The interview results showed that through psychological empowerment, employees were more involved in change process, took active role in decision making and were more committed to the change. The implications of the study can be used by organizational change practitioners to maintain employees’ positive reactions to change by considering psychological empowerment and organizational citizenship behaviors as a tool to lower the level of resistance.

Implementing shared decision-making in interprofessional home care teams (the IPSDM-SW study): protocol for a stepped wedge cluster randomised trial

IntroductionThe frail elderly in Canada face a tough decision when they start to lose autonomy: whether to stay at home or move to another location. This study seeks to scale...

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties.

A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. In-depth, qualitative interviews with specialty care providers in two specialties-orthopedics and cardiology-at two time points during DA implementation. Data were analyzed using a thematic analysis approach. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

Community Participation in attention to health; a little known right and non-exerted obligation

Community participation is one of the main axes of health services where the community takes responsibility for its own health. The World Health Organization considers as a cornerstone of the health promotion and disease preventive actions. The population should be involved in activities aimed at improving their health needs, previously identified by them because if their point of view is not taken into account, efforts generated by the health sector to improve their health conditions would result unsuccessful. Participation is an empowerment tool that allows the community a more active role in decision taking to enforce their rights. Achieving more effective prevention of diseases is one of the objectives of participation. No matter the adjective used (social, community..) participation implies to involve and empower citizens because it is essential to identify and approach main health determinants; it is required that a legal support that endorses participation exists; therefore, the General Health Law emphasizes the right of the population to participate in disease prevention. Some groups of community participation in México are Health Committee and Mutual Aid Group (Spanish: Grupo de Ayuda Mutua). Despite it is in all discourses, participation has not been concentrated in social action yet.

Role of Technical and Vocational Education and Training in Women Empowerment: A Case from Bima VDC of Myagdi District, Nepal

This study analyzed role of technical & vocational education and training in women empowerment process specifically in local level. In fact, technical & vocational education and training programs not only provide self-employment opportunity to the women but also trigger capability to exercise control over their personal and family life, make choices to improve well beings and take active role in decision making. For justifying central argument; what are the changing role of technical & vocational education and training that has been fostering women empowerment as well as social and economic development process in this VDC (Village Development Committee), the researchers employed quantitative case study research design and applied key informant interview, observation and household survey as data collection techniques. Researchers purposively selected 63 sample populations (10 respondents who completed technical & vocational education and 53 respondents who participated in vocational skill development trainings). The study found significant role of technical & vocational education and training that have been transforming women empowerment and social and economic development process in local level. More so, for promoting social and economic development process, capable and skilled women are equally playing; decision making, leadership, educational and change agent role in the VDC. The study concluded that technical & vocational education and training program conducting in local level help to nourish knowledge, ability and develop vocational skills of women and empowering them. Similarly, empowered women are also playing transformative role in social and economic development process of the VDC. Finally the ideas in which vocational education and training found to be means and ends for women empowerment in this VDC can be replicate in other similar settings.

Promoting the rights and responsibilities of children: a South Australian example.

In 2014, the Parafield Gardens Children's Centre for Early Childhood Development and Parenting was recognised as a Global Peace School - Early Years (GPSEY). During the recognition process, a project promoting the rights and responsibilities of children and families was facilitated. Partnering with children and families in decision making was a project priority. Young children had an active role in decision making. Through age-appropriate activities and discussions, children and families developed deeper understanding of child rights, peace building, global awareness and social inclusion. Educational staff were supported to enhance this child rights focus. A GPSEY recognition celebration acknowledged child rights and the community's cultural diversity. The outcome of GPSEY recognition is significant but the process that fostered community ownership, participation and social inclusion is worth noting. Involving children in decision making and development promotes their rights and responsibilities; this can make a positive difference for children locally, and globally.

Preparedness for surgery as a quality indicator.

80 Background: There has been growing attention to the informational priorities of patients in a shared decision making model of care. Patients report adequate information provision as an unmet need throughout their cancer experience. This is especially of concern when faced with complex decision making based on an understanding of medical information in an unfamiliar learning environment. This project is designed to identify informational priorities of patients related to diagnosis and treatment decisions. Methods: Patients’ perceived preparedness for surgery was measured to determine whether information needs were addressed and illustrate overall satisfaction with the surgical experience. A self-administered questionnaire was used to measure satisfaction with information related to diagnosis, treatment and recovery. Results: An active role in decision making that considers patients’ information needs increases satisfaction with treatment choices, preparedness for surgery and outcomes. Methods of providing information are often limited to written and verbal with written generally non-specific and not tailored to patients’ informational needs. Providers are also unable to control for access to other information sources such as the internet. Conclusions: A treatment plan developed through a shared decision making model should be evidence based including an assessment of the patient’s informational priorities. A combination of written and verbal information may be optimal with the written building on the verbal and not introducing new information. Encouraging recording of meetings may be helpful when stress becomes a barrier to comprehending and retaining the information. The patient should also be provided with reliable websites to supplement this information. This results in greater patient satisfaction with the interaction and overall surgical experience.

Patients’ preferred and perceived roles in making decisions about adjuvant chemotherapy for non-small-cell lung cancer

BackgroundPeople with cancer have varying preferences for involvement in decision-making between active, collaborative and passive roles. We sought the preferred and perceived involvement in decision-making among patients considering adjuvant chemotherapy (ACT) after resection of early non-small cell lung cancer (NSCLC). MethodsPatients considering ACT for NSCLC were asked to complete a self-administered questionnaire at baseline and 6 months. Preferred and perceived decision-making roles were assessed by the Control Preferences Scale (CPS). We examined differences between preferred and perceived roles, differences in preferred roles over time, determinants of preferences, and differences in treatment preferences between patients preferring active and less active roles. Results98 patients completed the baseline questionnaire; 75 completed the 6 month questionnaire. Most patients were male (55%) with a median age of 64 years (range, 43–79 years). Preferred role in decision-making at baseline (n=98) was active in 27%, collaborative in 47%, and passive in 27%. Perceived decision-making roles matched the preferred role in 79% of patients. Individuals’ role preferences often varied between baseline and 6 months, but there was no consistent direction to the change (25% changed preference to more active involvement, 22% to less active). Preferring a more active role was associated with university education (OR 2.9, p=0.02), deciding not to have ACT (OR 5.0, p<0.01), and worse health-related quality of life (HRQL) during ACT: physical well-being (OR 4.4, p=0.05), overall well-being (OR 5.5, p=0.02), sleep (OR 8.4, p<0.01) and shortness of breath (OR 7.6, p=0.01). Patients who preferred an active decision-making role judged larger survival benefits necessary to make ACT worthwhile than those preferring a passive role. ConclusionMost patients with resected NSCLC preferred and perceived a collaborative role in decision-making about ACT. Clinicians should elicit and consider patients’ preferences for involvement in decision-making when discussing ACT for NSCLC.

Initial Conditions Matter: Social Capital and Participatory Development

Billions of dollars have been spent on participatory development programs in the developing world. These programs give community members an active decision-making role. Given the emphasis on community involvement, one might expect that the effectiveness of this approach would depend on communities' pre existing social capital stocks. Using data from a large randomized eld experiment of Community-Led Total Sanitation in Indonesia, we nd that villages with high initial social capital built toilets and reduced open defecation, resulting in substantial health benets. In villages with low initial stocks of social capital, the approach was counterproductive|fewer toilets were built than in control communities and social capital suered.

Preferences of lung cancer patients for treatment and decision-making: a systematic literature review.

The consideration of patient preferences in decision-making has become more important, especially for life-threatening diseases such as lung cancer. This paper aims to identify the preferences of lung cancer patients with regard to their treatment and involvement in the decision-making process. We conducted a systematic literature review from 12 electronic databases and included studies published between 2000 and 2012. A total of 20 studies were included in this review. These revealed that lung cancer patients do have preferences that should be considered in treatment decisions; however, these preferences are not homogenous. We found that patients often consider life extension to be more important than the health-related quality of life or undesirable side effects. This preference seems to depend on patient age. Nausea and vomiting are the most important side effects to be avoided; the relevance of other side effects differs highly between subgroups. The majority of lung cancer patients, nevertheless, seem to prefer a passive rather than an active role in decision-making, although the self-reported preferences differed partly from the physicians' perceptions. Overall, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques.

Choosing a Model of Maternity Care: Decision Support Needs of Australian Women.

Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.

Acutely Bereaved Surrogates' Stories About the Decision to Limit Life Support in the ICU.

Participating in a decision to limit life support for a loved one in the ICU is associated with adverse mental health consequences for surrogate decision makers. We sought to describe acutely bereaved surrogates' experiences surrounding this decision. Qualitative analysis of interviews with surrogates approximately 4 weeks after a patient's death in one of six ICUs at four hospitals in Pittsburgh, PA. Adults who participated in decisions about life support in the ICU. Not applicable. We collected participant demographics, previous advance care planning, and decision control preferences. We used qualitative content analysis of transcribed interviews to identify themes in surrogates' experiences. The 23 participants included the spouse (n = 7), child/stepchild (7), sibling (5), parent (3), or other relation (1) of the deceased patient. Their mean age was 55, 61% were women, all were whites, 74% had previous treatment preference discussions with the patient, and 43% of patients had written advance directives. Fifteen of 23 surrogates (65%) preferred an active decision-making role, 8 of 23 (35%) preferred to share responsibility with the physician, and no surrogates preferred a passive role. Surrogates report that key stressors in the ICU are the uncertainty and witnessed or empathic suffering. These factors contributed to surrogates' sense of helplessness in the ICU. Involvement in the decision to limit life support allowed surrogates to regain a sense of agency by making a decision consistent with the patient's wishes and values, counteracting surrogates' helplessness and ending the uncertainty and suffering. In this all-white sample of surrogates with nonpassive decision control preferences from a single US region, participating in decision making allowed surrogates to regain control, counteract feelings of helplessness, and end their empathic suffering. Although previous research highlighted the distress caused by participation in a decision to limit life support, the act of decision making may, counterintuitively, help some surrogates cope with the experience.