The Impact of Trauma on End-of-Life Decision Making in the Intensive Care Unit
Nearly 60% of American adults experience traumatic life events (TLEs), such as physical abuse or interpersonal racism, with an even higher prevalence among racial minorities. The behavioral, cognitive, and health effects of TLEs may be reactivated when survivors of trauma perceive danger, such as having a loved one in an intensive care unit (ICU). For example, family members who have experienced TLEs may become anxious and withdrawn when asked to make decisions about their seriously ill loved one’s goals of care. As a result, clinicians who lack skills to recognize or respond to TLEs may label them as “difficult,” negatively impacting the family-clinician interaction. Specifically, family members with a history of TLEs may experience more interpersonal conflict with clinicians about treatment decisions, poorer quality of clinician communication, and weaker therapeutic alliance with clinicians. Importantly, these family-clinician interaction outcomes have been linked to longer lengths of stay and greater use of life support therapies among patients, and more burnout among clinicians. However, the impact of TLEs on family members of ICU patients has not been adequately evaluated.
Therefore, I propose a cross-sectional study of 100 Black and White family members of ICU patients who have been mechanically ventilated for ≥48 hours from 3 ICUs at Duke University.
Aim 1: Test the association between TLEs and family-clinician interaction outcomes (i.e., conflict, communication, and therapeutic alliance) reported by family members of ICU patients using surveys and regression models.
Aim 2: Characterize family and clinician beliefs about the impact of TLEs on the family-clinician interaction using semi-structured interviews.
Through this work, I will develop expertise in qualitative methods, health disparities research, and patient- and family-reported outcome measurement. The results of this study will directly inform a K23 Award application to develop and pilot test an intervention to promote trauma-informed care for ICU families.
Deepshikha Ashana, MD, received her undergraduate, medical, and
business degrees from the University of Pennsylvania. She completed internal
medicine residency at the University of California, Los Angeles. She then
worked as a management consultant at McKinsey and Company where she gained
experience in health system operations. While completing a fellowship in
pulmonary and critical care medicine at the University of Pennsylvania Health
System, she received formal training in research methods through a Master of
Science in Clinical Epidemiology. She is currently an Assistant Professor of
Medicine in the Division of Pulmonary and Critical Care at Duke University.