Factors Associated With Family Surrogate Decisional-Regret Trajectories

The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the 3 decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care.This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the 4 pre-identified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first 2 bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference.DECISION ANTECEDENT FACTORS: : Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more post-loss depressive symptoms increased odds for the late-emerging trajectory. More pre- and post-loss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anti-cancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anti-cancer or life-sustaining treatments increased odds for the late-emerging trajectory.Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.