Abstract Details

Title Subtypes of Insecure Psychological Attachment Styles as Predictors of Neuro ICU Goals-of-care Decisions

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S48 - Neurocritical Care: Traumatic Brain Injury and Goals-of-care Decision-making (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective We hypothesized that various subtypes of insecure psychological attachment styles among Neuro ICU surrogate decision makers are predictive of requests to prolong life-sustaining therapy (LST) for patients with devastating brain injury.

Background The model of attachment theory describes how people respond when separated from loved ones. Adults can be secure or one of three insecure subtypes: dismissing-avoidant (comfortable mostly without close emotional relationships), fearful-avoidant (seeking close relationships but having difficulty trusting others), or preoccupied (seeking close relationships but concerned about one’s own value).

Design/Methods We administered a two-part survey to family members of patients admitted to a single ICU. In addition to collecting patient and family demographics, we identified each family respondent’s attachment style via a standard tool, the Relationship Questionnaire. We presented each respondent a hypothetical scenario of an intubated severely brain-injured patient in the Neuro ICU and asked each respondent whether they would request LST (tracheostomy and gastrostomy) or CMO (comfort measures only) for the patient. We conducted univariate and multivariate analyses to determine predictors of LST selection.

Results 275/689 (39.9%) eligible respondents participated. Regarding attachment style, 153 (55.6%) family members were secure, 61 (22.2%) were dismissing-avoidant, 40 (14.5%) were fearful-avoidant, and 21 (7.6%) were preoccupied. 53 (19.3%) selected LST, and 222 (80.7%) selected CMO. 45.3% of participants who selected LST were uncertain, compared to 9.5% of participants who selected CMO (p<.001). Univariate distributions of attachment styles among those selecting LST vs. CMO did not differ (p=0.87). In a multivariate model, non-white race (OR 4.30, 95% CI 1.95-9.48) and religiosity (i.e., attending religious services more than a “few times a week,” 5.58, 2.22-14.03) were significant predictors of LST selection.

Conclusions Insecure attachment styles were not identified as independent predictors of selecting LST. However, those selecting LST overall were less certain, and race and religiosity were predictive of LST selection.

Authors/Disclosures
Qiang Zhang PRESENTER	Mrs. Zhang has nothing to disclose.
	No disclosure on file
Prerak Juthani (Yale School of Medicine)	Mr. Juthani has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
David Y. Hwang, MD, FAAN (University of North Carolina School of Medicine)	The institution of Dr. Hwang has received research support from NIH. The institution of Dr. Hwang has received research support from Neurocritical Care Foundation. Dr. Hwang has received publishing royalties from a publication relating to health care. Dr. Hwang has received personal compensation in the range of $10,000-$49,999 for serving as a Associate Medical Director with New England Donor Services.

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