• Karen O Moss, Sara L Douglas, Eric Baum, and Barbara Daly.
• Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center. moss.391@osu.edu.
• Crit Care Nurse. 2019 Jun 1; 39 (3): e18-e26.

BackgroundCaring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process.ObjectivesTo explore family surrogate decision-making for people with chronic critical illness.MethodsIn this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis.ResultsFamily surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as "frustrating," most surrogates reported that they were "comfortable" with this role. Major decision-making themes were "communication as key in decision-making," "impact of past experiences," and "difficulties and coping." Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges.ConclusionsResults support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes.©2019 American Association of Critical-Care Nurses.

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