The relationships among emotion regulation, role stress, and psychological distress in surrogate decision makers of the chronically critically ill patients

Abstract

<p><strong>Background:</strong> Advancement in technologies has contributed to patients surviving critical illness, but continuing to live with chronically critically ill conditions. A majority of such patients experience transient or persistent states of decisional impairment requiring family members or authorized surrogate decision makers to render treatment decisions. Abrupt transition to the surrogate decision maker role often evokes heightened stress. Research shows that emotion regulation can help manage situational stress.</p> <p><strong>Purpose:</strong> To examine the associations among emotion regulation, role stress, and psychological distress in surrogate decision makers of chronically critically ill patients in intensive care units.</p> <p><strong>Methods:</strong> A descriptive, secondary analysis of 120 surrogate decision makers of chronically critically ill patients from various intensive care units within an academic medical center in Northeast Ohio. Parent investigation data were used to address the following questions: (1) what are the associations among emotion regulation (cognitive reappraisal &amp; expressive suppression), role stress, psychological distress, and demographic variables of age, gender, ethnicity, kinship, advance directives, and living will of surrogate decision makers of chronically critically ill patients? (2) what is the relationship between emotion regulation and psychological distress while controlling for surrogate decision makers&rsquo; demographic variables? (3) does role stress mediate therelationship between emotion regulation and psychological distress while controlling for demographic variables of surrogate decision makers of chronically critically ill patients? Pearson r and Spearman rho correlations and Multiple Regression tests were conducted to answer these questions.</p> <p><strong>Findings:</strong> Statistically significant associations included: role stress and psychological distress (r = .29, p &lt; .01), gender and role stress ((r = .22, p &lt; .05), gender and psychological distress (r = .27, p &lt; .01), kinship and role stress (r = .29, p &lt; .01), race and psychological distress (r = .18, p &lt; .05), and suppression and advance directives (r = .21, p &lt; .05). Emotion regulation was not significantly associated with psychological distress and role stress did not mediate the relationship between emotion regulation and psychological distress.</p> <p><strong>Implications:</strong> Surrogate decision makers require psychological support while making decisions. Gender specific support and increased emphasis on advance directives are also required. Innovative support programs for surrogate decision makers need further research.</p>