Emotional support is important, and not only for surrogates’ psychological well-being: It’s also linked to the quality of their decision-making, found a recent study.1

As the population ages, a growing number of people will find themselves faced with making decisions for a family member. “We wanted to know if there are things we can do as healthcare providers to relieve their stress,” says Alexia Torke, MD, MS, who led the study. Torke is associate director of Indiana University’s Center for Aging Research and a research scientist at Regenstrief Institute, both in Indianapolis.

The researchers surveyed 364 surrogate decision-makers using a newly developed Family Inpatient Communication Survey. This measured two aspects of communication: information and emotional support during the patient’s hospitalization or shortly afterward.2

“We wanted to see if quality of communication is associated with the stress they feel. If it is, that might be a point where we can intervene,” says Torke.

The researchers expected these individuals to have high levels of anxiety and depression. “Other studies have shown that decision-making is stressful — not only in the ICU, but in the hospital setting,” notes Torke.

A more striking finding was just how important emotional support is — not only for the surrogate, but also the patient. Participants who agreed that “hospital staff really listened to me when we talked” tended to make higher-quality decisions. Provision of information, with participants agreeing that they received as much detail about their loved one’s care as they needed, was less important in terms of quality decision-making.

Researchers also assessed surrogates’ anxiety, depression, and post-traumatic stress disorder (PTSD), both during the hospital stay and six to eight weeks later. “Information and emotional support affected outcomes differently,” says Torke.

Emotional support was associated with less anxiety, depression, and PTSD. Receiving high-quality information was linked to higher overall satisfaction during the hospital stay, but was not associated with less anxiety, depression, and PTSD.

Notably, while some of the surrogate distress experienced during the acute illness resolved, it remained high for more than 10% of surrogates. Interestingly, researchers found that receiving more information without emotional support was associated with higher levels of PTSD. “It is an intriguing finding that needs more exploration,” says Torke. “But it does suggest that providing just information without emotional support might be stressful.”

The study’s findings suggest that improved emotional support could lead to better decisions for the patient, and better psychological outcomes for the surrogate. This underscores the ethical obligation of the healthcare team to consider surrogates’ psychological well-being, says Torke.

“We do have an obligation to family members as well as to our patients, to support them during these difficult times,” says Torke. Support does not need to come from the physicians, or even the clinical team. It can come from chaplains, social workers, or ethicists, or a healthcare team member who already is involved in the patient’s care, even indirectly.

“Yes, hospitals are busy places, but families appreciate support from any member of the interdisciplinary team,” says Torke. “It should be everyone’s responsibility.”

No matter how much advance care planning is done, surrogates still need support when actual decisions must be made. “We need to recognize the impact that making decisions has on people,” says Torke. “No matter what happens with the patient, the family survives with the memory of what happened in the hospital.”


1. Torke AM, Callahan CM, Sachs GA, et al. Communication quality predicts psychological well-being and satisfaction in family surrogates of hospitalized older adults: An observational study. J Gen Intern Med 2017 Nov 28. doi: 10.1007/s11606-017-4222-8. [Epub ahead of print]

2. Torke AM, Monahan P, Callahan CM, et al. Validation of the family inpatient communication survey. J Pain Symptom Manage 2017; 53(1):96-108.


• Alexia Torke, MD, MS, Associate Director, Indiana University Center for Aging Research, Indianapolis. Phone: (317) 503-8084. Email: atorke@iupui.edu.