Understanding factors that predispose surrogates of patients with devastating brain injury towards requesting LST is important for improving goals-of-care decision making processes in Neuro ICUs. The psychological model of “attachment theory” describes how people respond when separated from loved ones. Adults can be “secure” (comfortable depending on others and being alone) or “insecure.” Insecure individuals view themselves as insufficient and/or others as untrustworthy, preventing them from seeking support during times of adversity.

We administered a two-part survey to family members of patients admitted to a Neuro ICU at an academic medical center. Families of survivors and non-survivors were both enrolled. The first part of the survey defined a respondent’s attachment style via a standard tool, the Relationship Questionnaire. The second part presented a hypothetical scenario of a severely brain-injured patient in the Neuro ICU and asked respondents whether they would request LST or CMO (comfort measures only) for the patient. Fisher’s exact test was used to compare frequency of LST selection between groups.

Between December 2017 and July 2018, 250/703 (35.6%) eligible family members completed both parts of the survey. 141/250 (56.4%) family members reported secure attachment, while 109/250 (43.6%) reported insecure styles. Among 141 secure individuals, 25 (17.7%) indicated they would select LST, compared to 26 among the 109 insecure individuals (23.8%) (p=0.27).

Our results suggest that any difference in the proportion of secure vs. insecure surrogate decision makers favoring LST for a devastatingly brain-injured Neuro ICU patient is likely small. However, future research may focus on assessing decision preferences among surrogates with various subtypes of insecure attachment.