Family decision-makers in medical crises benefit from emotional support

(Reuters Health) - Making medical decisions for a hospitalized older relative can be very stressful, but family members may be less traumatized and make better decisions when they receive support from healthcare workers, a study suggests.

Nearly half of hospitalized older adults need help communicating and making healthcare decisions, and caregivers often experience stress while helping their loved ones, researchers write in the Journal of General Internal Medicine.

“Millions of older adults are admitted to the hospital each year, and as the country’s population ages, this is going to be more common,” said lead author Dr. Alexia Torke of the Indiana University Center for Aging Research in Indianapolis.

Prior research has focused on patients in intensive care units (ICUs), but the new study found high stress levels for family decision-makers throughout the hospital, she told Reuters Health by phone.

Torke and colleagues studied 364 adults, age 65 or older, and their surrogate decision-makers in ICUs or internal medicine units at three hospitals. Family members faced at least one tough decision during the hospital stay about life-sustaining therapy such as ventilator use or resuscitation orders, procedures or surgeries requiring written informed consent, or placement in a nursing home.

At the start of the study and six weeks after the patient left the hospital, researchers assessed levels of anxiety, depression and post-traumatic stress disorder (PTSD) in the family decision-maker. Decision-makers also filled out feedback surveys about the quality of communication and emotional support they experienced, and their satisfaction with decision-making during the relative’s hospitalization and satisfaction with the hospital overall.

While their relative was hospitalized, decision-makers had fairly high levels of anxiety and depression. But six to eight weeks post-discharge, just 23 percent had lingering anxiety, about half of them at a moderate to severe level. A total of 29 percent had mild depression, about half had moderate to severe depression, and 14 percent had symptoms of PTSD.

Decision-makers who felt they received emotional support from hospital workers were 35 percent less likely to have lingering anxiety and 20 percent less likely to have ongoing depression, compared to those who didn’t feel supported.

This effect was independent of family characteristics, anxiety levels at the start of the study and whether the patient died, the researchers note.

Emotional support was also linked to lower likelihood of PTSD and higher satisfaction with decision-making. In contrast, high satisfaction with information communication was associated with higher odds of PTSD, but also higher overall satisfaction with the hospital.

“Family surrogates are going to be distressed after a hospital stay, even if there’s good communication with hospital staff,” Torke said. “What really matters is the emotional support.”

Future studies should look at ways to improve communication and emotional support, the authors write. At Indiana University medical centers, for example, a tool called the Family Navigator provides health information and emotional support to family surrogates in the ICU, Torke said.

“This should serve as a call-to-action for hospitals and healthcare systems,” said Dr. J. Randall Curtis, a critical care specialist at the University of Washington in Seattle, who wasn’t involved in the study.

“What we really need are studies that identify specific approaches that doctors, nurses, social workers and hospitals can use to improve communication and emotional support,” he told Reuters Health by email. “We need to demonstrate that these approaches work.”

Some studies show that condolence letters actually make symptoms worse, he said. Instead, a trained social worker or palliative care provider may provide the emotional support and communication that patients and their loved ones really need.

“Having a seriously ill loved one is extremely stressful, and family members of hospitalized patients should think about the way they can get their communication needs met,” Curtis said. “If you are in this situation, consider asking for help.”