DEVELOPMENT AND VALIDATION OF THE SURROGATE DECISION-MAKER TRUST SCALE

Surrogate decision-makers (SDM) of incapacitated patients in the adult ICU setting serve a vital role in making healthcare decisions for critically ill patients. However, these SDMs may suffer negative physical and emotional outcomes from carrying the burden of this responsibility. High-quality communication between the healthcare team and the SDM may mitigate some of the negative effects of decision-making on SDMs, but a prerequisite to this type of communication is SDM trust in healthcare professionals (HCPs). In order to develop interventions to increase trust and improve SDM outcomes, trust must be quantifiable, but there is currently no validated instrument with which to measure SDM trust in HCPs. Chapter 2: “A Concept Analysis of Trust Within the Surrogate Decision Maker to Health Care Professional Relationship in the Adult ICU Setting,” provides a newly developed conceptual definition of SDM trust in HCPs. This chapter also discusses antecedents of trust, those realities that must be present prior to the existence of trust, and consequences of trust, both positive and negative. Empirical referents that provide evidence of the presence of SDM trust in HCPs are also examined. Chapter 3: “A Scoping Review of Surrogate Decision-Maker Trust in Healthcare Professionals in the Adult ICU Setting,” describes a literature review to identify and map what is known about SDM trust in HCPs in this setting. The results of the review were mapped to a conceptual model to help organize and interpret the findings. Trust-building interventions and trust-related outcomes were identified. This review confirmed a significant gap in the literature due to the absence of a validated instrument with which to measure SDM trust in HCPs in the adult ICU setting. Chapter 4: “Development and Validation of the Surrogate Decision-Maker Trust Scale,” reports on a research study to create an instrument to measure SDM trust in HCPs in the adult ICU setting. Forty-five initial items were written based on the literature review presented in chapter 3. This item bank was refined through content validity testing and regularized exploratory factor analysis down to a final list of 22 questions that made up the Surrogate Decision-Maker Trust Scale (SDMTS). Chapter 5 summarizes the previous chapters and suggests next steps to build on this dissertation research. The practical implications of this research for nursing practice, education, and future research are examined. Recommendations for confirmatory factor analysis and further validity testing are given.