Visitation restriction and decision making: Healthcare surrogate experiences

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. Practice Implications: Visitation restriction carries risk such as delaying decision-making and the perceived healing benefits of visitation. •Healthcare surrogates felt that visitation restrictions impeded healing and grief rituals.•Healthcare surrogates desire to make medical decisions in conjunction with the patient.•Visitation restrictions may have delayed important decision-making in the intensive care unit.•Future visitation restrictions should consider how surrogates make decisions.