Other Titles
Rising Star Poster/Presentation
Abstract
Making medical decisions for patients with impaired decision-making capacity due to serious illness is a stressful experience for surrogate decision makers (SDMs), which can result in emotional and psychological distress6,7 and delayed decision-making3. Uncertainty has been identified as a key contributor to the stress experienced by SDMs in decision-making1. High-quality communication addressing uncertainty improves the decision-making experience for SDMs2,3. Yet, there is a lack of targeted education to help healthcare providers effectively address uncertainty in communication with SDMs. Purpose statement: This study aims to identify techniques and strategies clinicians use to address various aspects of uncertainty experienced by the SDMs of hospitalized patients. Methods: The Uncertainty in Illness Theory (UIT) posits there are 8 key constructs involved in an individual’s perception of uncertainty related to an illness and its impact on psychological adjustment: stimuli frame, credible authority, social support, education, mobilizing strategies, affect control strategies, buffering strategies, and adjustment4,5. This study examined whether the essential communication skills endorsed by experts mapped to the key constructs discussed in UIT. Guided by UIT, we conducted a secondary analysis of qualitative data from a Delphi study involving 79 experts in serious illness communication worldwide who identified communication skills necessary for conversations with SDMs of hospitalized patients with serious illnesses, with and without concomitant dementia. Using deductive coding, we validated themes already discussed in the UIT framework under the key constructs, while inductive coding captured additional themes related to communication skills or strategies. Results: Results revealed that the majority of the Delphi-endorsed communication skills identified fell into the 8 distinct constructs of the UIT. 27 themes of techniques or strategies used by clinicians were identified across the 8 constructs, including assessing uncertainty sources, fostering trust, providing education, offering emotional or social support, and facilitating adjustment. Application: Our results support UIT as a practical framework for understanding communication behaviors that influence SDM uncertainty and coping. These findings can guide translational research and the development of communication training programs for clinicians working with SDMs of seriously ill patients.
Notes
References:
1. Kim, H., Cho, J., Shin, S., & Kim, S. S. (2024). Uncertainty in surrogate decision-making about end-of-life care for people with dementia: An integrative review. Journal of Advanced Nursing, 80(8), 3103-3118. https://doi.org/https://doi.org/10.1111/jan.16038
2. Kwak, J., & Noh, H. (2018). What matters to persons with dementia at the end of life: Perspectives of proxy decision makers. Journal of Hospice & Palliative Nursing, 20(5), 478-485. https://doi.org/10.1097/njh.0000000000000465
3. Lamahewa, K., Mathew, R., Iliffe, S., Wilcock, J., Manthorpe, J., Sampson, E. L., & Davies, N. (2018). A qualitative study exploring the difficulties influencing decision making at the end of life for people with dementia. Health Expectations, 21(1), 118-127.
4. Mishel, M. H. (1988). Uncertainty in Illness. Image: the Journal of Nursing Scholarship, 20(4), 225-232. https://doi.org/https://doi.org/10.1111/j.1547-5069.1988.tb00082.x
5. Mishel, M. H. (1990). Reconceptualization of the Uncertainty in Illness Theory. Image: the Journal of Nursing Scholarship, 22(4), 256-262. https://doi.org/https://doi.org/10.1111/j.1547-5069.1990.tb00225.x
6. Su, Y., Yuki, M., & Hirayama, K. (2020). The experiences and perspectives of family surrogate decision-makers: A systematic review of qualitative studies. Patient Education and Counseling, 103(6), 1070-1081. https://doi.org/https://doi.org/10.1016/j.pec.2019.12.011
7. Wendlandt, B., Ceppe, A., Choudhury, S., Nelson, J. E., Cox, C. E., Hanson, L. C., Danis, M., Tulsky, J. A., & Carson, S. S. (2018). Risk factors for post-traumatic stress disorder symptoms in surrogate decision-makers of patients with chronic critical illness. Annals of the American Thoracic Society, 15(12), 1451-1458. https://doi.org/10.1513/AnnalsATS.201806-420OC
Sigma Membership
Eta
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Clinician Strategies, Uncertainty in Illness Theory, UIT, Communication Techniques
Recommended Citation
Zhu, Jiayi and Seaman, Jennifer Burgher, "Mapping Expert-Endorsed Communication Skills With Surrogates to Uncertainty in Illness Theory" (2025). Creating Healthy Work Environments (CHWE). 100.
https://www.sigmarepository.org/chwe/2025/presentations_2025/100
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
None: Event Material, Invited Presentation
Acquisition
Proxy-submission
Mapping Expert-Endorsed Communication Skills With Surrogates to Uncertainty in Illness Theory
Phoenix, Arizona, USA
Making medical decisions for patients with impaired decision-making capacity due to serious illness is a stressful experience for surrogate decision makers (SDMs), which can result in emotional and psychological distress6,7 and delayed decision-making3. Uncertainty has been identified as a key contributor to the stress experienced by SDMs in decision-making1. High-quality communication addressing uncertainty improves the decision-making experience for SDMs2,3. Yet, there is a lack of targeted education to help healthcare providers effectively address uncertainty in communication with SDMs. Purpose statement: This study aims to identify techniques and strategies clinicians use to address various aspects of uncertainty experienced by the SDMs of hospitalized patients. Methods: The Uncertainty in Illness Theory (UIT) posits there are 8 key constructs involved in an individual’s perception of uncertainty related to an illness and its impact on psychological adjustment: stimuli frame, credible authority, social support, education, mobilizing strategies, affect control strategies, buffering strategies, and adjustment4,5. This study examined whether the essential communication skills endorsed by experts mapped to the key constructs discussed in UIT. Guided by UIT, we conducted a secondary analysis of qualitative data from a Delphi study involving 79 experts in serious illness communication worldwide who identified communication skills necessary for conversations with SDMs of hospitalized patients with serious illnesses, with and without concomitant dementia. Using deductive coding, we validated themes already discussed in the UIT framework under the key constructs, while inductive coding captured additional themes related to communication skills or strategies. Results: Results revealed that the majority of the Delphi-endorsed communication skills identified fell into the 8 distinct constructs of the UIT. 27 themes of techniques or strategies used by clinicians were identified across the 8 constructs, including assessing uncertainty sources, fostering trust, providing education, offering emotional or social support, and facilitating adjustment. Application: Our results support UIT as a practical framework for understanding communication behaviors that influence SDM uncertainty and coping. These findings can guide translational research and the development of communication training programs for clinicians working with SDMs of seriously ill patients.
Description
This presentation examines clinician strategies for addressing uncertainty in communication with surrogate decision-makers (SDMs) of seriously ill patients. Guided by the Uncertainty in Illness Theory (UIT), the study identifies 27 communication techniques across eight UIT constructs, such as fostering trust and providing education. Attendees will explore how UIT can guide communication training, enhance interactions, and support SDMs in making informed decisions during high-stress situations.