Abstract

Background: Under heightened states of high uncertain and emotional distress, surrogate decision makers (SDMs) are often expected to make informed medical decisions that align with the critically patient’s preferences for life-sustaining care. Under these circumstances, some SDMs use spiritual and religious coping (SRC) to mitigate the negative influence of situational and role-related stressors. However, there is a relative dearth of evidence that has explored the relationships among SRC and other determinants of surrogate decision making, such as SDM’s depressive symptoms, role stress and decision making self-efficacy, on the perceived care preference of the critically ill patient.

Purpose: To evaluate the direct and indirect influence of SRC on key determinants of surrogate decision making and care preference.

Methods: This is a cross-sectional, correlational study consisting of a convenience sample of 281 SDMs of critically ill adults. A battery of measures were administered to capture the SDMs’ sociodemographic data, SRC, depressive symptoms, role stress, decision making self-efficacy, and the perceived care preferences of patients. Data were analyzed using descriptive statistics and a path analysis.

Results: Our sample was predominantly, middle-aged (M = 54.4, SD = 13.6), white (76%), female (73%), and identified as being a relative (94%) of the critically ill patient. The path model had excellent fit to the data (c² = 26.7, p = .37; TLI = .99; CFI = .98, RMSEA = .02). Depressive symptoms (b = -.14, p < .05) and decision making self-efficacy (b = .16, p < .05) was directly associated with spiritual and religious coping. However, the only direct predictor of care preference was decision making self-efficacy (b = -.21, p < .05).

Conclusion: These data clearly provide evidence that SRC influences depressive symptom severity and the decision making self-efficacy of SDMs. Based on our findings, we recommend that future research explore how to incorporate SRC into decision support interventions to improve SDMs’ decision making self-efficacy and delivery of preference concordant care to the critically ill.

Keywords: Spiritual and Religious Coping; Surrogate Decision Makers; Critically Ill; Decision Making Self-Efficacy

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