Assessing surrogate decision makers' state anxiety following a request for a Do Not Resuscitate order

An ethical dilemma resulting in anxiety is experienced by surrogates who are required to make end-of-life decisions on behalf of other family members. This study focused on the variable levels of state anxiety of surrogates following requests to approve Do Not Resuscitate (DNR) orders. The objectives were to determine the extent to which the measured levels of state anxiety varied with respect to (a) whether the surrogate was a member of the nuclear or the extended family and/or (b) whether or not the surrogate knew the DNR wish of the patient. The results were applied to make practical recommendations regarding the provision of support for surrogates who are required to approve DNR orders. A quasi-experimental quantitative research methodology based on the State Trait Anxiety Inventory (STAI) was used to analyze the relative levels of state anxiety experienced by surrogates two or more years after approving DNR orders. Multivariate statistical analysis revealed that all surrogate DNR decision makers experience state anxiety; however, members of the nuclear family of the patient experience higher levels of anxiety than members of the extended family. Decision makers who are nuclear family members experience a lower anxiety level if they know the DNR wishes of the patient. The findings were consistent with that predicted by family system theory. More research needs to be conducted to explore the multiple factors that influence the variability in the anxiety levels of surrogate DNR decision makers. Appropriate approaches to provide clinical and social support should be researched and developed in order to alleviate the state anxiety of surrogates and to help them make better informed DNR decisions that do not compromise the healthcare of the patient.