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The following is a summary of “Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients,” published in the April 2025 issue of Journal of Critical Care by Hill-Oliva et al. 

Surrogates made substituted judgments for individuals with critical neurological illness, while resilience and spirituality remained inadequately explored.  

Researchers conducted a retrospective study to evaluate the accuracy of surrogate estimates of resilience and spirituality for individuals who were neurologically critically ill.  

They enrolled patients with neurological critical illness-surrogate dyads who spoke English or Spanish from March 2016 to 2018. Questionnaires assessed resilience (CD-RISC-10), spiritual well-being (positive Brief R-COPE), and spiritual turmoil (negative Brief R-COPE). Patients completed self-assessments, while surrogates provided responses on the behalf in the Neurosciences Intensive Care Unit (ICU). Spearman’s rank-order correlation, Bland-Altman analysis, and Cohen’s weighted kappa were used to evaluate the responses, and were evaluated by Spearman’s rank-order correlation, Bland-Altman analysis, and Cohen’s weighted kappa.  

The results showed that 51 dyads were included. No correlation was observed between patient and surrogate scores for the CD-RISC-10 (0.17, P = 0.238). Moderate positive correlations were found for positive Brief R-COPE (0.47, P < 0.001) and negative Brief R-COPE (0.33, P = 0.021). Mean differences between patient and surrogate scores were minimal for CD-RISC-10 (−1.0 point), positive Brief R-COPE (−0.14 point), and negative Brief R-COPE (0.02 point), indicating no systematic bias in estimation. Kappa scores demonstrated fair inter-rater agreement for positive and negative Brief R-COPE but no agreement for CD-RISC-10. 

Investigators concluded that while surrogate evaluations did not show systematic bias, they may not have reliably estimated resilience and spirituality in patients with neurological critical illness. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124004623