Visitation restriction and decision making: Healthcare surrogate experiences.

Abstract

We sought to discover whether hospital visitation restrictions imposed during COVID, and remaining at some institutions, influenced surrogate decision-making. Thematic analysis of semi-structured interviews of people who served as healthcare surrogates for patients admitted to the intensive care unit with a palliative care consultation in January of 2021 at a large tertiary care hospital. Thirteen healthcare surrogates agreed to be interviewed out of the fifty-six who were identified and invited to participate. The following themes emerged: 1) Decision-making was delayed as surrogates desire to make decisions in conjunction with the patient; 2) visitation restriction disrupted processes of grief and end-of-life rituals; 3) it prevented healing that occurs with closeness to loved ones; 4) visitation permission was poorly communicated and inconsistent; 5) virtual connection was inconsistent and proved ineffective in context; 6) communication was often stressful and confusing. From the point of view of healthcare surrogates, visitation restriction disrupted the normal process of decision-making by impeding important healing and grief rituals, and making connection difficult, despite policies and technology that was meant to assist. Visitation restriction carries risk such as delaying decision-making and the perceived healing benefits of visitation.