Subtypes of Insecure Psychological Attachment Styles as Predictors of Neuro ICU Goals-of-care Decisions

Objective: We hypothesized that various subtypes of insecure psychological attachment styles among Neuro ICU surrogate decision makers are predictive of requests to prolong life-sustaining therapy (LST) for patients with devastating brain injury. Background: The model of attachment theory describes how people respond when separated from loved ones. Adults can be secure or one of three insecure subtypes: dismissing-avoidant (comfortable mostly without close emotional relationships), fearful-avoidant (seeking close relationships but having difficulty trusting others), or preoccupied (seeking close relationships but concerned about one’s own value). Design/Methods: We administered a two-part survey to family members of patients admitted to a single ICU. In addition to collecting patient and family demographics, we identified each family respondent’s attachment style via a standard tool, the Relationship Questionnaire. We presented each respondent a hypothetical scenario of an intubated severely brain-injured patient in the Neuro ICU and asked each respondent whether they would request LST (tracheostomy and gastrostomy) or CMO (comfort measures only) for the patient. We conducted univariate and multivariate analyses to determine predictors of LST selection. Results: 275/689 (39.9%) eligible respondents participated. Regarding attachment style, 153 (55.6%) family members were secure, 61 (22.2%) were dismissing-avoidant, 40 (14.5%) were fearful-avoidant, and 21 (7.6%) were preoccupied. 53 (19.3%) selected LST, and 222 (80.7%) selected CMO. 45.3% of participants who selected LST were uncertain, compared to 9.5% of participants who selected CMO (p Conclusions: Insecure attachment styles were not identified as independent predictors of selecting LST. However, those selecting LST overall were less certain, and race and religiosity were predictive of LST selection. Disclosure: Dr. Zhang has nothing to disclose. Dr. Knies has nothing to disclose. Dr. Juthani has nothing to disclose. Dr. Tu has nothing to disclose. Dr. Pach has nothing to disclose. Dr. Martinez has nothing to disclose. Dr. Hwang has nothing to disclose.