By Stacey Kusterbeck
During medical training and early clinical practice spanning several major cities and diverse patient populations, Scott Vasher, MD, observed that some patients, or their surrogate decision-makers, had an intrinsic trust in the healthcare team. Others seemed mistrustful.
“This led me to wonder if surrogate decision-makers’ medical mistrust could impact the decision-making process,” says Vasher, now an assistant professor of medicine at UChicago Medicine.
Vasher and colleagues conducted a study to measure surrogate decision-maker medical mistrust and identify risk factors for higher medical mistrust.1 The researchers enrolled 29 adult patients who were admitted to the medical intensive care unit (ICU) in 2022-2023 and 29 surrogate decision-makers.
Black race and previous exposure to hospice or comfort-focused care was associated with higher medical mistrust. Religiousness was associated with lower medical mistrust.
“Building and maintaining trust with surrogate decision-makers is a very important piece of providing medical care to patients experiencing critical illness,” says Vasher. Clinicians need to pay attention to verbal and nonverbal cues that might suggest mistrust in the healthcare system, adds Vasher. If mistrust appears to be an issue, clinicians can address it by investing extra time building rapport with families.
“Ethically, our obligation is to optimize communication with surrogate decision-makers to provide care that is consistent with the patient’s values and avoid harm,” underscores Vasher.
Ethicists can play an important role in addressing medical mistrust at their institutions by helping to resolve communication issues. “Ethicists can help reinforce the idea that trust and mistrust exist based on lived experiences,” adds Vasher. If medical mistrust goes unaddressed, it can complicate end-of-life decision-making. Ethicists may get involved as the result of conflicts between the family and the clinical team. “If medical mistrust is contributing to the situation, the ethicist’s role can be to reframe the situation around who the patient is, what their values are, and how care can be provided that is in line with those values,” says Vasher.
Reference
1. Vasher ST, Laux J, Carson SS, et al. Predictors of medical mistrust among surrogate decision-makers of patients in the ICU at high risk of death: A pilot study. CHEST Crit Care. 2024;2(4):100092.
During medical training and early clinical practice, Scott Vasher, MD, observed that some patients, or their surrogate decision-makers, had an intrinsic trust in the healthcare team. Others seemed mistrustful. Vasher and colleagues conducted a study to measure surrogate decision-maker medical mistrust and identify risk factors for higher medical mistrust.
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