Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients

Background: Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population. In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients. Methods: A convenience sample of English/Spanish speaking neurologically critically ill patient-surrogate dyads was enrolled from March 2016 to 2018. Questionnaires related to resilience (CD-RISC-10), spiritual wellbeing (positive Brief R-COPE), and spiritual turmoil (negative Brief R-cope) were completed by patients for themselves and surrogates on behalf of patients while in the Neurosciences Intensive Care Unit. Responses were evaluated by Spearman's rank-order correlation, Bland-Altman analysis and Cohen's weighted kappa. Results: 51 dyads were included. No correlation was found between patient and surrogate CD-RISC-10 (0.17, p = 0.238); moderate, positive correlations for positive (0.47, p < 0.001) and negative (0.33, p = 0.021) Brief R-COPE. Mean differences between patient and surrogate scores were low for CD-RISC-10 (−1.0 point), positive R-COPE (− 0.14 point), and negative R-COPE (0.02 point) suggesting lack of bias towards over/under-estimation. Kappa scores demonstrate fair inter-rater agreement for positive/negative R-COPE and no agreement for CD-RISC-10. Conclusion: Surrogate evaluations lack systematic bias, but may not estimate resilience and spirituality reliably for neurologically critically ill patients.