Supporting families faced with making critical decisions for incapacitated loved ones is a core ethical duty for ICU clinicians. “Yet little is known about family characteristics that predict their dissatisfaction with support during decision-making,” says David Y. Hwang, MD, FAAN, FCCM, FNCS, an associate professor of neurology at Yale.

To learn more, Hwang and colleagues surveyed 355 family members at two academic medical centers.1 Patients stayed an average 8.6 days. Families who decided to keep a patient as full code, without any treatment limitations, tended to be less satisfied. About half indicated they were dissatisfied with the amount of support available when difficult decisions needed to be made.

The researchers studied several factors to see which predicted dissatisfaction. Race, level of education, and prior ICU experience were not predictive of dissatisfaction. The only significant predictor of dissatisfaction with decision-making support was a family member reporting three or fewer family meetings during the ICU hospitalization. “If ethicists are involved in designing protocols and methods for improving decision-making support in ICUs, focusing on initiatives that increase families’ perceptions of number of family meetings with the clinical team may be a worthwhile core strategy,” Hwang says. 


  1. Weber U, Zhang Q, Ou D, et al. Predictors of family dissatisfaction with support during neurocritical care shared decision-making. Neurocrit Care 2021:1-9.