Development and Validation of Decision Needs Scale for Surrogates of Patients When Considering an Invasive Procedure in an Intensive Care Unit.

Abstract

Background: Patients admitted to intensive care units often rely on surrogates for decision making, especially for invasive procedures. Over 70% of decisions are related to invasive procedures. Surrogates' unmet needs during decision making can lead to conflicts. Existing scales assess the general needs of surrogates, and tools designed explicitly for invasive procedure decision making are lacking, necessitating the development of targeted assessments for use by healthcare professionals.

Aim: This study aimed to develop and evaluate the reliability and validity of the Surrogate Decision Needs Scale (SDNS) for surrogates of critically ill patients considering invasive procedures.

Study design: This study was conducted at a medical centre. Two clinical and research experts drafted assessment items based on a literature review, which was refined by five experts. A cross-sectional design with convenience sampling was used to measure the needs of the surrogates. Exploratory factor analysis and known group analysis examined the scale's construct validity, while internal consistency reliability was evaluated using Cronbach's alpha.

Results: The expert content validity index of the SDNS was 0.93-1. A convenience sample of 100 surrogates of ICU patients completed the 16 items SDNS, and 132 invasive procedures were analysed. Exploratory factor analysis revealed three factors: Information Needs, Support Needs and Recourse Needs, which explained 70.13% of the total variance. Known-group analysis showed that having a high educational level (p = 0.001) and being a child of the patient (p = 0.021) were associated with placing high importance on information, support and resource needs during decision making.

Conclusions: The SDNS effectively assesses the needs of ICU surrogates in making decisions about invasive procedures. Findings suggest that surrogate education level and relationship to the patient may influence decision priorities, with college-educated surrogates prioritising information needs while children serving as surrogates emphasised support needs. Future research should explore the SDNS's applicability in diverse cultural settings and surrogate roles to determine whether these patterns are consistent across different populations. Longitudinal studies are needed to examine the trajectory of surrogates' decision needs, particularly in cases involving invasive procedures.

Relevance to clinical practice: Healthcare professionals should address decision needs by explaining the risks associated with invasive procedures, discussing specific recommendations with patients' family members and allowing surrogates sufficient time for contemplation before decision-making.