Surrogates Do Not Accurately Estimate Resilience and Religious Coping In Neurocritical Care Patients

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

1-2023

Journal Title

Critical Care Medicine

Department

Neurology

Abstract

RESEARCH SNAPSHOT THEATER: PATIENT & FAMILY SUPPORT

569: SURROGATES DO NOT ACCURATELY ESTIMATE RESILIENCE AND RELIGIOUS COPING IN NEUROCRITICAL CARE PATIENTS

Hill-Oliva, Michael1; Medavarapu, Srinivas2; Chada, Deeksha1; Keogh, Maggie1; Gordon, Errol1; Mayer, Stephan3; Dangayach, Neha4

Author Information Critical Care Medicine 51(1):p 272, January 2023. | DOI: 10.1097/01.ccm.0000908004.31696.81

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Introduction: While patient resilience and spirituality play an important role in the care and recovery of critically ill patients, these constructs are difficult to evaluate when patients suffer from severe acute brain injuries (SABI). For SABI patients, surrogates are relied upon for shared decision making to provide care in line with a patient’s goals, values and wishes. Resilience and spirituality are understudied in SABI, perhaps in part because measuring these constructs in the Neurosciences Intensive Care Unit (NSICU) is difficult. The goal of this study is to compare evaluations of resilience and religious coping by patients and their surrogates and determine whether surrogate estimates are accurate and reliable.

Methods: Patient-surrogate dyads who were admitted to the Mount Sinai Hospital NSICU from March 2016 to 2018 were enrolled. The Connor-Davidson Resilience Scale (CD-RISC) and Brief R-COPE questionnaires were administered to dyads to measure resilience and religious coping. Patients who could not answer the questionnaires for themselves or did not have a surrogate were excluded. Spearman’s rank-order correlation, Bland-Altman agreement and Cohen’s weighted kappa tests were conducted to assess for correlation and agreement in resilience and religious coping between dyads.

Results: 51 dyads were enrolled into the study. Spearman coefficients indicate a low, positive correlation between patient and surrogate reporting of positive R-COPE (0.47,p< 0.001) and negative R-COPE (0.33,p=0.021), and no significant correlation for CD-RISC (0.17,p=0.238). Bland-Altman plots demonstrate mean differences (95% CI) of -1.0 (-19.51,17.51) for CD-RISC, -0.14 (-12.43,12.15) for positive R-COPE score, and 0.02 (-12.05,12.09) for negative R-COPE score, reflecting a low systemic bias. Patient vs surrogate positive and negative R-COPE scores have a Kappa statistic of 0.372 and 0.279 respectively, indicating a fair level of agreement, and no significant agreement for CD-RISC.

Conclusions: While surrogate evaluations of patient resilience and religious coping do not demonstrate a systemic bias towards over- or under-estimation, they do not estimate patient reported scores with a high degree of reliability. Surrogates’ estimations of religious coping appear to be slightly more reliable than estimations of resilience.

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