• Paul J Hutchison, Katie McLaughlin, Tom Corbridge, Kelly N Michelson, Linda Emanuel, Peter H S Sporn, and Megan Crowley-Matoka.
• 1Division of Pulmonary and Critical Care, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.2Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL.3Division of Pulmonary and Critical Care, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.4Division of Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.5Buehler Center on Aging, Health & Society, Feinberg School of Medicine, Northwestern University, Chicago, IL.6Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL.7Jesse Brown Veterans Affairs Medical Center, Department of Medicine, Chicago, IL.
• Crit. Care Med. 2016 Dec 1; 44 (12): 2208-2214.

ObjectiveIn the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU.DesignProspective qualitative study.SettingMedical ICU of a major urban university hospital.SubjectsSurrogate decision makers of intubated, mechanically ventilated patients in the medical ICU.Measurements And Main ResultsSemistructured interviews focused on surrogates' general experiences in the ICU and on their trust in the clinicians caring for the patient. Interviews were audio-recorded, transcribed verbatim, and coded by two reviewers. Constant comparison was used to identify themes pertaining to trust. Thirty surrogate interviews revealed five dimensions of trust in ICU clinicians: technical competence, communication, honesty, benevolence, and interpersonal skills. Most surrogates emphasized the role of nurses in trust formation, frequently citing their technical competence. Trust in physicians was most commonly related to honesty and the quality of their communication with surrogates.ConclusionsInterventions to improve trust in the ICU should be role-specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust. Further research is needed to confirm our findings and explore the impact of trust modification on clinician-family conflict.

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