Abstract / Summary
Abstract Background: Surrogate decision-makers often make time-sensitive decisions about invasive respiratory support for patients with cancer and respiratory failure while facing uncertainty about prognosis, treatment burden, and the patient's preferences. This study aimed to assess decisional conflict in this setting and identify clinical and communication-related factors associated with it, with particular attention to prior end-of-life discussions.
Methods: A cross-sectional questionnaire study was conducted among 307 surrogate decision-makers of patients with cancer and respiratory failure admitted to the intensive care unit (ICU) of a specialized oncology hospital in Sichuan Province, China, between January and November 2024. Decisional conflict was assessed using the Chinese version of the 16-item Decisional Conflict Scale (DCS). Univariate analyses and multiple linear regression were used to identify factors associated with DCS scores.
Results: The mean DCS score was 50.30 ± 8.73, and 97.4% of participants had high-level decisional conflict. In multivariable analysis, higher decisional conflict was associated with no surgery during the current admission (B = 10.20, P < 0.001), fewer hospitalizations (B = -3.87, P < 0.001), having no relatives or friends working in healthcare (B = 2.20, P = 0.043), insufficient knowledge of the patient's disease (B = 6.21, P < 0.001), and no prior discussion of end-of-life issues with the patient (B = 7.01, P < 0.001). The model explained 48.3% of the variance in DCS scores.
Conclusions: Decisional conflict was highly prevalent among surrogate decision-makers facing decisions about invasive respiratory support for patients with cancer and respiratory failure. Limited treatment experience, insufficient disease-related knowledge, lack of access to medical information, and absence of prior end-of-life communication were associated with greater conflict. Earlier goals-of-care communication, values clarification, and tailored decision support may help clinicians identify and support surrogate decision-makers with greater decisional needs.