Family Surrogates' Decision Regret and Psychological Stress about End-of-Life Cancer Treatments: Path Analysis

Su Hyun Kim

doi:10.4040/jkan.2018.48.5.578

Journal List > J Korean Acad Nurs > v.48(5) > 1106712

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim: Family Surrogates' Decision Regret and Psychological Stress about End-of-Life Cancer Treatments: Path Analysis

Original Article

Journal of Korean Academy of Nursing 2018; 48(5): 578-587.

Published online: 31 October 2018

DOI: https://doi.org/10.4040/jkan.2018.48.5.578

Family Surrogates' Decision Regret and Psychological Stress about End-of-Life Cancer Treatments: Path Analysis

Su Hyun Kim

College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea.

Address reprint requests to : Kim, Su Hyun. College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaebosang-ro, Daegu 41944, Korea. Tel: +82-53-420-4928, Fax: +82-53-421-2758, suhyun_kim@knu.ac.kr

Received 10 July 2018 Revised 13 September 2018 Accepted 14 September 2018

Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to understand the mechanisms of decision regret and stress of family surrogates' end-of-life decision making using an exploratory path model. In particular, the research identified the direct effects of perceptions of uncertainty and effective decisions on decision regret and stress, and examined the indirect effects of being informed, having clear values, and being supported for decision regret and the stress of end-of-life decision making through the mediating variables of perceptions of uncertainty and effective decisions.

Methods

Data were collected from 102 family surrogates who had participated in end-of-life decision making for patients with terminal cancer in a tertiary hospital.

Results

Perception of effective decisions was a significant direct predictor of decision regret, and uncertainty was a significant predictor of stress among the participants. Being informed, having clear values, and being supported had a significant indirect influence on decision regret through the perception of effective decisions among family surrogates. However, only having clear values had a significant indirect influence on stress through the perception of uncertainty. The model explained 63.0% of decision regret and 20.0% of stress among the participants and showed a good fit with the data, χ²=12.40 (df=8, p=.134), TLI=.97, and RMSEA=.07.

Conclusion

Nurses can support family surrogates in end-oflife decision-making processes to decrease their decision regret by providing information about end-of-life care choices, clarifying personal values, and supporting the decision-making process, and to relieve their stress by facilitating the clarification of personal values.

Keywords: Decision Making, Family, Neoplasms, Terminal Care

Figures and Tables

Figure 1

Path analysis on family surrogates' decision regret and stress about end-of-life treatments decision making.

Table 1

Characteristics of the Participants

M=Mean; SD=Standard Deviation.

Table 2

Item Scores for Effective Decisions, Uncertainty, and Modifiable Factors in Decision Making among Family Surrogates

IQR=Interquartile range; CI=Confidence interval.

Table 3

Zero-Order Correlations among the Study Variables

Table 4

Direct and Indirect Effects Associated with Decision Regret and Stress

ACKNOWLEDGEMENTS

I would like to appreciate Bomin Jeon who granted me the use of her data for this study.

Notes

^{CONFLICTS OF INTEREST} The author declared no conflict of interest.

References

1. Ministry of Government Legislation. Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life [Internet]. Sejong: Ministry of Government Legislation;cited 2018 Jan 2. Available from: http://www.law.go.kr/법령/호스피스ㆍ완화의료및임종과정에있는환자의연명의료결정에관한법률/(14013,20160203).

2. Lee GS, Jung HS, Hwang SY, Choi DB. Effective management plan for health care expenditure for older adults in preparation of older society. Seoul: Korea Institute for Health & Welfare Policy;2017. p. 62.

3. Bioethics Policy Research Center. Survey on withdrawal of life-sustaining treatment and advanced directives. Seoul: Bioethics Policy Research Center;2011. p. 8.

4. Hussey PS, Wertheimer S, Mehrotra A. The association between health care quality and cost: A systematic review. Ann Intern Med. 2013; 158(1):27–34. DOI: 10.7326/0003-4819-158-1-201301010-00006.

5. Teno JM, Curtis JR. Family perspectives on aggressive cancer care near the end of life. JAMA Oncol. 2016; 2(7):957–957. DOI: 10.1001/jamaoncol.2016.0441.

6. Lee JK, Keam B, An AR, Kim TM, Lee SH, Kim DW, et al. Surrogate decision-making in Korean patients with advanced cancer: A longitudinal study. Support Care Cancer. 2013; 21(1):183–190. DOI: 10.1007/s00520-012-1509-5.

7. Chang WK, Ahn KJ, Kim MY, Kim YR, Han YJ. The role of a patient’s family when the withdrawal of life-sustaining treatment is expected: A narrative analysis. Korean J Med Ethics. 2015; 18(2):172–189.

8. Hickman RL Jr, Daly BJ, Lee E. Decisional conflict and regret: Consequences of surrogate decision making for the chronically critically ill. Appl Nurs Res. 2012; 25(4):271–275. DOI: 10.1016/j.apnr.2011.03.003.

9. Park EY. The experience of family members on deciding to withdraw life-sustaining treatment for patients who are terminally ill [dissertation]. Seoul: Yonsei University;2003. 1–110.

10. Zeelenberg M, van Dijk WW, Manstead AS. Regret and responsibility resolved? Evaluating Ordóñez and Connolly's (2000) conclusions. Organ Behav Hum Decis Process. 2000; 81(1):143–154. DOI: 10.1006/obhd.1999.2865.

11. Brehaut JC, O'Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, et al. Validation of a decision regret scale. Med Decis Making. 2003; 23(4):281–292. DOI: 10.1177/0272989X03256005.

12. O'Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995; 15(1):25–30. DOI: 10.1177/0272989X9501500105.

13. Sun Q. Predicting downstream effects of high decisional conflict: Meta-analyses of the decisional conflict scale [master's thesis]. Ottawa (ON): University of Ottawa;2005. 1–82.

14. Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and predictors of decision regret about health care decisions: A systematic review. Med Decis Making. 2016; 36(6):777–790. DOI: 10.1177/0272989X16636113.

15. Wendler D, Rid A. Systematic review: The effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011; 154(5):336–346. DOI: 10.7326/0003-4819-154-5-201103010-00008.

16. O'Connor AM. User manual-Decisional conflict scale [Internet]. Ottawa (ON): Ottawa Hospital Research Institute;c1993. cited 2018 Feb 1. Available from: https://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Decisional_Conflict.pdf.

17. Ivo K, Younsuck K, Ho YY, Sang-Yeon S, Seog HD, Hyunah B, et al. A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan. Korean J Med Ethics. 2012; 38(5):310–316. DOI: 10.1136/medethics-2011-100153.

18. Lee J, Jung D, Choi M. Relationship of social support and decisional conflict to advance directives attitude in Korean older adults: A community-based cross-sectional study. Jpn J Nurs Sci. 2016; 13(1):29–37. DOI: 10.1111/jjns.12081.

19. Gong HS, Park JW, Shin YH, Kim K, Cho KJ, Baek GH. Use of a decision aid did not decrease decisional conflict in patients with carpal tunnel syndrome. BMC Musculoskelet Disord. 2017; 18(1):118. DOI: 10.1186/s12891-017-1478-4.

20. Sim JA, Shin JS, Park SM, Chang YJ, Shin A, Noh DY, et al. Association between information provision and decisional conflict in cancer patients. Ann Oncol. 2015; 26(9):1974–1980. DOI: 10.1093/annonc/mdv275.

21. Jeon BM, Kim SH, Lee SJ. Decisional conflict in end-of-life cancer treatment among family surrogates: A cross-sectional survey. Nurs Health Sci. 2018; 06. 19. Forthcoming. DOI: 10.1111/nhs.12537.

22. Bentler PM, Chou CP. Practical issues in structural modeling. Sociol Methods Res. 1987; 16(1):78–117. DOI: 10.1177/0049124187016001004.

23. Cha ES, Park MY, Kim GA. A comparison analysis of somatotype, physical activity, mental health, healthy behavior between normal weight and overweight college students in Korea. Korean J Health Promot Dis Prev. 2008; 8(4):245–255.

24. Kellar SP, Kelvin EA. Munro's statistical methods for health care research. 6th ed. Philadelphia (PA): Wolters Kluwer Health;2013. p. 365.

25. Hamano J, Morita T, Fukui S, Kizawa Y, Tunetou S, Shima Y, et al. Trust in physicians, continuity and coordination of care, and quality of death in patients with advanced cancer. J Palliat Med. 2017; 20(11):1252–1259. DOI: 10.1089/jpm.2017.0049.

26. Shim HY, Park JH, Kim SY, Shin DW, Shin JY, Park BY, et al. Discordance between perceived and actual cancer stage among cancer patients in Korea: A nationwide survey. PLoS One. 2014; 9(5):e90483. DOI: 10.1371/journal.pone.0090483.

27. Johnson S, Butow P, Kerridge I, Tattersall M. Advance care planning for cancer patients: A systematic review of perceptions and experiences of patients, families, and healthcare providers. Psychooncology. 2016; 25(4):362–386. DOI: 10.1002/pon.3926.

28. Chiarchiaro J, Buddadhumaruk P, Arnold RM, White DB. Prior advance care planning is associated with less decisional conflict among surrogates for critically ill patients. Ann Am Thorac Soc. 2015; 12(10):1528–1533. DOI: 10.1513/AnnalsATS.201504-253OC.

29. Hecker K. Critical synthesis package: Decisional conflict scale (DCS). MedEdPORTAL. 2015; 11:10273. DOI: 10.15766/mep_2374-8265.10273.

30. Cardona-Morrell M, Benfatti-Olivato G, Jansen J, Turner RM, Fajardo-Pulido D, Hillman K. A systematic review of effectiveness of decision aids to assist older patients at the end of life. Patient Educ Couns. 2017; 100(3):425–435. DOI: 10.1016/j.pec.2016.10.007.

31. Pignatiello G, Hickman RL Jr, Hetland B. End-of-life decision support in the ICU: Where are we now? West J Nurs Res. 2018; 40(1):84–120. DOI: 10.1177/0193945916676542.

32. Cuypers M, Lamers RE, Kil PJ, van de Poll-Franse LV, de Vries M. Impact of a web-based treatment decision aid for early-stage prostate cancer on shared decision-making and health outcomes: Study protocol for a randomized controlled trial. Trials. 2015; 16:231. DOI: 10.1186/s13063-015-0750-x.

TOOLS

ORCID iDs: Su Hyun Kim
https://orcid.org/0000-0003-4268-6437
Similar articles