CONTEXT Regret plays a central role in surrogate decision making. Research on decisional regret in family surrogates is scarce and lacks longitudinal studies to illustrate the heterogenous, dynamic evolution of decisional regret. OBJECTIVES To identify distinct decisional-regret trajectories from end-of-life (EOL) decision making through the first two bereavement years among surrogates of cancer patients. METHODS A prospective, longitudinal, observational study was conducted on a convenience sample of 377 surrogates of terminally ill cancer patients. Decisional regret was measured by the five-item Decision Regret Scale monthly during the patient's last six months and 1, 3, 6, 13, 18, and 24 months post loss. Decisional-regret trajectories were identified using latent-class growth analysis. RESULTS Surrogates reported substantially high decisional regret (pre- and postloss mean [SD] as 32.20 [11.47] and 29.90 [12.47], respectively). Four decisional-regret trajectories were identified. The resilient trajectory (prevalence: 25.6%) showed a general low decisional-regret level with mild and transient perturbations around the time of patient death only. Decisional regret for the delayed-recovery trajectory (56.3%) accelerated before the patient's death and decreased slowly throughout bereavement. Surrogates in the late-emerging (10.2%) trajectory reported a low decisional-regret level before loss but their decisional regret increased gradually thereafter. The increasing-prolonged trajectory (6.9%) rapidly increased in decisional-regret levels during EOL decision making, peaked one-month post loss, then declined steadily but without a complete resolution. CONCLUSION Surrogates heterogeneously suffered decisional regret from EOL decision making through bereavement as evident by four identified distinct decisional-regret trajectories. Early identification and prevention of increasing/prolonged decisional-regret trajectories is warranted.

中文翻译：

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通过丧亲之痛做出的临终决策的决策后悔轨迹。


背景 后悔在替代决策中起着核心作用。关于家庭代理人决策后悔的研究很少，也缺乏纵向研究来说明决策后悔的异质性、动态演变。目的 确定癌症患者代理人在前两年丧亲之年的临终 (EOL) 决策中不同的决策后悔轨迹。方法 对 377 名末期癌症患者的替代者进行​​了一项前瞻性、纵向、观察性研究。在患者最后六个月以及失去亲人后的 1、3、6、13、18 和 24 个月内，每月通过五项决策后悔量表来衡量决策后悔。使用潜在类别增长分析来确定决策后悔轨迹。结果 代理人报告了相当高的决策后悔（损失前和损失后平均 [SD] 分别为 32.20 [11.47] 和 29.90 [12.47]）。确定了四种决策后悔轨迹。弹性轨迹（患病率：25.6%）显示，决策后悔程度总体较低，仅在患者死亡前后出现轻微且短暂的扰动。对延迟康复轨迹的决定性遗憾（56.3%）在患者死亡前加速，并在丧亲期间缓慢减少。后发代孕者（10.2%）在失去亲人之前表示对决定的后悔程度较低，但此后他们的决定后悔程度逐渐增加。在 EOL 决策过程中，决策后悔水平迅速上升，在损失后一个月达到峰值，然后稳步下降，但没有完全解决。 结论 代孕妈妈在丧亲之痛期间因 EOL 决策而遭受的决策后悔程度不同，这可以从四种不同的决策后悔轨迹中看出。有必要及早识别和预防增加/延长的决策后悔轨迹。