The Effect of Emotion and Physician Communication Behaviors on Surrogates’ Life-Sustaining Treatment Decisions: A Randomized Simulation Experiment.
The Effect of Emotion and Physician Communication Behaviors on Surrogates’ Life-Sustaining Treatment Decisions: A Randomized Simulation Experiment.
Crit Care Med. 2013 May 8;
Barnato AE, Arnold RM
OBJECTIVE:: Surrogate decision makers for critically ill patients experience strong negative emotional states. Emotions influence risk perception, risk preferences, and decision making. We sought to explore the effect of emotional state and physician communication behaviors on surrogates’ life-sustaining treatment decisions. DESIGN:: 5 × 2 between-subject randomized factorial experiment. SETTING:: Web-based simulated interactive video meeting with an intensivist to discuss code status. SUBJECTS:: Community-based participants 35 and older who self-identified as the surrogate for a parent or spouse recruited from eight U.S. cities through public advertisements. INTERVENTIONS:: Block random assignment to emotion arousal manipulation and each of four physician communication behaviors. MEASUREMENTS AND MAIN RESULTS:: Surrogate’s code status decision (cardiopulmonary resuscitation versus do not resuscitate/allow natural death). Two hundred fifty-six of 373 respondents (69%) logged-in and were randomized: average age was 50; 70% were surrogates for a parent; 63.5% were women; 76% were white, 11% black, and 9% Asian; and 81% were college educated. When asked about code status, 56% chose cardiopulmonary resuscitation. The emotion arousal manipulation increased the score on depression-dejection scale (? = 1.76 [0.58 – 2.94]) but did not influence cardiopulmonary resuscitation choice. Physician attending to emotion and framing the decision as the patient’s rather than the surrogate’s did not influence cardiopulmonary resuscitation choice. Framing no cardiopulmonary resuscitation as the default rather than cardiopulmonary resuscitation resulted in fewer surrogates choosing cardiopulmonary resuscitation (48% vs 64%, odds ratio, 0.52 [95% CI, 0.32-0.87]), as did framing the alternative to cardiopulmonary resuscitation as “allow natural death” rather than do not resuscitate (49% vs 61%, odds ratio, 0.58 [95% CI, 0.35-0.96]). CONCLUSIONS:: Experimentally induced emotional state did not influence code status decisions, although small changes in physician communication behaviors substantially influenced this decision. HubMed – depression
Trait pessimism predicts vulnerability to stress-induced anhedonia in rats.
Neuropsychopharmacology. 2013 May 10;
Rygula R, Papciak J, Popik P
Depressive disorder is often associated with cognitive biases. In this study, we took a unique opportunity to investigate whether trait pessimism could predict vulnerability to stress-induced anhedonia in an animal model of depression. In a series of ambiguous-cue interpretation (ACI) tests, we identified animals displaying ‘pessimistic’ and ‘optimistic’ traits. Subsequently, the rats were subjected to chronic restraint, and the trait differences in response to stress were investigated using sucrose preference and ACI tests before, during and after the stress regime. Although stress resulted in anhedonia in both subgroups, it occurred faster and lasted longer in the ‘pessimistic’ compared to the ‘optimistic’ animals. Chronic stress exposure also increased the negative judgment bias in rats, although this effect was not dependent on the ‘pessimistic’ trait. For the first time, we demonstrated a link between cognitive judgment bias and vulnerability to stress-induced anhedonia in an animal model. We also introduced a cognitive biomarker, which may be of value for etiological depression studies.Neuropsychopharmacology accepted article preview online, 10 May 2013; doi:10.1038/npp.2013.116. HubMed – depression