# Surrogate Trust in the Intensive Care Unit: What Can We Do Better?

## TL;DR

This study explores how much trust ICU patients' surrogates have in healthcare providers and the system, finding higher trust in individual doctors than in the system itself.

## Contribution

This is the first pilot study to measure surrogate trust in the ICU setting, highlighting differences in trust between providers and the healthcare system.

## Key findings

- Surrogates reported higher trust in individual physicians compared to the healthcare system.
- Trust in physician competence was higher than trust in physician values.
- Findings suggest opportunities for improving communication and family-centered care in the ICU.

## Abstract

Background/Objectives: Previous investigation into patients’ trust in medical providers is largely limited to the outpatient setting, where increased trust is associated with improved adherence, satisfaction, and self-reported quality of life. Contrastingly, in the intensive care unit (ICU), patients are frequently incapacitated, and it is surrogates that engage with clinicians for decision making. This pilot study aims to measure and compare surrogate trust in the healthcare system and ICU physicians. Methods: We measured surrogate trust in both the healthcare system and providers by administering two domain-specific trust-measuring surveys (the Healthcare System Distrust Scale and a modified Trust in Physicians Scale) to surrogates of mechanically ventilated medical ICU patients at an urban academic medical center between November 2021 and April 2024. Results: Responses from twenty-seven surrogates were included in the analysis. The overall mean distrust in healthcare system score was 19.29 (SD 5.8). The overall mean trust in individual physician score was 42.4 (SD 6.26). When subdivided into specific domains, surrogates reported higher mean scores for trust in healthcare system and physician competence than values. Conclusions: In our population, surrogates for medical ICU patients are overall more trusting of their medical providers than the healthcare system. Moreover, surrogates are more trusting of a provider’s professional competence and knowledge than a provider’s values. Our findings may inform trust-building interventions designed specifically for the high-acuity ICU setting to improve quality in communication and family-centered care.