The following is a summary of “Decisional-Regret Trajectories From End-of-Life Decision Making Through Bereavement,” published in the March 2023 issue of Pain Management by Wen, et al.
There needed to be more research on decisional regret in family surrogates and limited longitudinal studies that capture the diverse and evolving nature of decisional regret in end-of-life (EOL) decision-making. For a study, researchers sought to identify different trajectories of decisional regret among surrogates of cancer patients, spanning from EOL decision-making to the first two years of bereavement.
A prospective, longitudinal, observational study was conducted with a convenience sample of 377 surrogates of terminally ill cancer patients. Decisional regret was assessed monthly using the five-item Decision Regret Scale during the patient’s last six months of life and at 1, 3, 6, 13, 18, and 24 months post-loss. Latent-class growth analysis was used to identify distinct decisional-regret trajectories.
Surrogates consistently reported high levels of decisional regret, both before and after the loss of the patient (mean [SD] scores of 32.20 [11.47] and 29.90 [12.47], respectively). About 4 decisional-regret trajectories were identified. The resilient trajectory (prevalence: 25.6%) showed consistently low levels of decisional regret with minor fluctuations around the time of the patient’s death. The delayed-recovery trajectory (56.3%) exhibited increased decisional regret before the patient’s death, followed by a gradual decline throughout bereavement. Surrogates in the late-emerging trajectory (10.2%) initially reported low decisional regret, which gradually increased after the loss. The increasing-prolonged trajectory (6.9%) experienced a rapid increase in decisional regret during EOL decision-making, reaching its peak one month after the loss and gradually declining without complete resolution.
The study revealed distinct decisional-regret trajectories among surrogates, highlighting the heterogeneous nature of decisional regret from EOL decision-making to bereavement. Early identification and prevention of increasing/prolonged decisional-regret trajectories are crucial in supporting surrogates throughout this challenging process.