Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit
Open accessAbstract
Background: Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU). This qualitative study surveyed a purposive sample of surrogates (n = 8; average age, 48 years) of cancer patients in the ICU of a medical center in Taiwan. A phenomenological methodology was used, and a purposive sample of surrogates of cancer patients were recruited and interviewed during the first three days of the ICU stay. Results: Based on the interview results, four themes were generalized through text progression: (1) Use love to resist: internal angst. This theme was related to the reflexive self -blame, the feelings of inner conflict, and the reluctance to make healthcare decisions, which surrogates experienced when they perceived suffering by the patient. (2) Allow an angel to spread love among us: memories and emotional entanglements. Memories of the patient caused the surrogate to experience emotional entanglements ranging from happiness to sadness and from cheerfulness to anger. (3) Dilemmas of love: anxiety about ICU visitor restrictions. The confined space and restricted visiting hours of the ICU limited the ability of surrogates to provide emotional support and to share their emotions with the patient. (4) Suffocating love: entanglement in decision-making. Emotional entanglements among family members with different opinions on medical care and their struggles to influence decision-making often prevented surrogates from thinking logically. Conclusions: Expression of emotions by ICU surrogates is often restrained and implicit, particularly in Asian populations. These results can help health professionals understand the psychological shock and inner conflict experienced by surrogates and provide a useful reference for improving their communications with surrogates.
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Insufficient comprehension of ECMO's potential benefits, risks, complications, and prognosis can heighten uncertainty and anxiety.
“Insufficient comprehension of ECMO’s potential benefits, risks, complications, and prognosis can heighten uncertainty and anxiety34.”
From Decisional conflict among Chinese family caregivers prior to ECMO initiation: a cross-sectional study (2025) · cites this paper as [34]
The Results (§§3.3–3.4; page not provided) describe limited medical understanding, uncertainty about treatment outcomes, and surrogates’ distress and fear. The paper does not address ECMO or link comprehension of its specific benefits, risks, complications, and prognosis to heightened uncertainty and anxiety. (LLM, conf=0.84)
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- Authors
- Sun, W.-N., Hsu, H.-T., Ko, N.-Y., & Huang, Y.-T.
- Affiliations
- National Cheng Kung University Hospital (TW)
- Kaohsiung Medical University (TW)
- Chang Gung Memorial Hospital (TW)
- Corresponding author
- Hsu, Hsin-Tien
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2020-06-20
- Volume
- 17
- Issue
- 12
- Pages
- 4443
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC7345805
- OpenAlex
- W3036849100
- Cited by
- 23
- References
- 21
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 2
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministry of Science and Technology, Taiwan (MOST-108-2635-B-037-007)
- National Cheng Kung University Hospital (NCKUH-10607004)
- Topics
- Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Keywords
- surrogate decision-making, cancer patients, intensive care unit, family caregivers, emotional entanglement, self-blame, family conflict, emotional restraint, Asian populations
- MeSH terms
- Adult, Asia, Decision Making, Humans, Intensive Care Units, Middle Aged, Neoplasms, Taiwan, Proxy
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