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Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit

Author

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  • Wan-Na Sun

    (Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan)

  • Hsin-Tien Hsu

    (School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung 807, Taiwan
    Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan)

  • Nai-Ying Ko

    (Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan)

  • Yu-Tung Huang

    (Center for Big Data Analytic and Statistics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan)

Abstract

Background : Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU). This qualitative study surveyed a purposive sample of surrogates ( n = 8; average age, 48 years) of cancer patients in the ICU of a medical center in Taiwan. A phenomenological methodology was used, and a purposive sample of surrogates of cancer patients were recruited and interviewed during the first three days of the ICU stay. Results : Based on the interview results, four themes were generalized through text progression: (1) Use love to resist: internal angst. This theme was related to the reflexive self -blame, the feelings of inner conflict, and the reluctance to make healthcare decisions, which surrogates experienced when they perceived suffering by the patient. (2) Allow an angel to spread love among us: memories and emotional entanglements. Memories of the patient caused the surrogate to experience emotional entanglements ranging from happiness to sadness and from cheerfulness to anger. (3) Dilemmas of love: anxiety about ICU visitor restrictions. The confined space and restricted visiting hours of the ICU limited the ability of surrogates to provide emotional support and to share their emotions with the patient. (4) Suffocating love: entanglement in decision-making. Emotional entanglements among family members with different opinions on medical care and their struggles to influence decision-making often prevented surrogates from thinking logically. Conclusions: Expression of emotions by ICU surrogates is often restrained and implicit, particularly in Asian populations. These results can help health professionals understand the psychological shock and inner conflict experienced by surrogates and provide a useful reference for improving their communications with surrogates.

Suggested Citation

  • Wan-Na Sun & Hsin-Tien Hsu & Nai-Ying Ko & Yu-Tung Huang, 2020. "Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit," IJERPH, MDPI, vol. 17(12), pages 1-15, June.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:12:p:4443-:d:374285
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    References listed on IDEAS

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    1. Fei‐Hsiu Hsiao & Steven Klimidis & Harry Minas & Eng‐Seong Tan, 2006. "Cultural attribution of mental health suffering in Chinese societies: the views of Chinese patients with mental illness and their caregivers," Journal of Clinical Nursing, John Wiley & Sons, vol. 15(8), pages 998-1006, August.
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    Cited by:

    1. Yi-Jhen He & Ming-Hwai Lin & Jo-Lan Hsu & Bo-Ren Cheng & Tzeng-Ji Chen & Shinn-Jang Hwang, 2021. "Overview of the Motivation of Advance Care Planning: A Study from a Medical Center in Taiwan," IJERPH, MDPI, vol. 18(2), pages 1-12, January.

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