END-OF-LIFE DECISION MAKING FOR SURROGATE DECISION MAKERS IN THE INTENSIVE CARE UNIT AND IMPLICATIONS FOR NURSING PRACTICE

Abstract

Background: Healthcare disparities are a significant problem in the U.S., particularly among African Americans and is evident in the increased usage of more aggressive end-of-lifecare in the intensive care unit and a lesser propensity for hospice or palliative care. These disparities have the potential to cause additional suffering for patients and place a burden upon families who act as surrogate decision makers.Aim and objectives: To gain an understanding of the end-of-life decision making experiences of African American surrogate decision makers regarding interactions with nurses. To analyze how communication between nurses and AA end-of-life decision makers impacts treatment preferences and to describe how interactions with ICU nurses affect the quality of end-of-life. Methods: A qualitative study using narrative inquiry through one-on-one interviews 30 African Americans was conducted. Analysis and Results: Inductive and deductive data analysis using a critical race lens was conducted using a process called ‘Framework’ Four themes were identified with subthemes including racism and its impact on the perception of hospital reputation among AA, structural/institutional racism, unconscious bias, medical mistrust, health and health system literacy, and of recognition of the non-nuclear family. Recommendations: Further study is needed about African American patients and families during end-of-life decision making in the ICU to guide nurses into using a more culturally sensitive approach.