2021 Scientist Development Awards – Dr. Dustin Krutsinger

The sixth annual UNMC Department of Internal Medicine Scientist Development Award was recently awarded to Dustin Krutsinger, MD MSCE, Assistant Professor within the Division of Pulmonary, Critical Care, and Sleep Medicine for his proposal titled "Exploring the Impact of Unengaged Stakeholders and Intra-Family Conflict in Critical Care Surrogate Decision Making."
 
As part of the award, Dr. Krutsinger will receive support for one year and will dedicate 50 percent of his time to research, career development, and other scholarly activities.
 
In his proposal, he will be conducting qualitative interviews of ICU surrogate decision makers to understand the impact that unengaged stakeholders and intra-family conflict surrounding medical decisions has on surrogate short- and long- term psychological morbidity, the quality of the decision-making process, and timeliness of decision making.
 
Although ICU patients often have a singular primary surrogate decision maker, whom the clinicians focus their engagement with, he recognizes that there are often other stakeholders involved in decision making, which he hypothesizes may result in several important implications. First, to the extent that the primary surrogate is waiting for a consensus among all stakeholders, delayed engagement may lead to delayed decisions. Second, relying on the primary decision maker to relay information to other stakeholders may result in incomplete or misunderstandings of the clinical situation and thus may lead to poor decision making. Third, the added pressures of being an intermediary and being the focal point of intra-family conflict in regard to medical decisions likely increases short- and long-term psychological morbidity by the primary surrogate decision maker.
 
Through qualitative interviewing of ICU primary surrogate decision makers he will explore 1) who are the stakeholders involved in the decision making process, 2) how they are informed of the clinical situation and the decisions that need to be made, 3) the presence of intra-family conflict, 4) the impact of intra-family conflict on the psychological wellbeing of the primary surrogate, 5) any delays in decision making due to stakeholder engagement and 6) ways that clinicians can engage stakeholders and facilitate quality and timely decision making. 
 
Paul Estabrooks, PhD, and Kristina Bailey, MD, will serve as Dr. Krutsinger’s co-mentors for this grant. Dr. Estabrooks is the Harold M. Maurer Distinguished Chair and Professor in the College of Public Health. Dr. Estabrooks has experience in qualitative methods and decision science while Dr. Bailey is an experienced intensivist with years of experience guiding families through difficult decisions. Both Dr. Estabrooks and Dr. Bailey have federal funding as well as a long track record of mentoring young physician-scientists to successful independent careers.
 
The Department of Internal Medicine accepted applications for its Scientist Development Award in January, later than usual due to delays caused by the COVID-19 pandemic. The award is designed to support promising Department of Internal Medicine faculty during their early careers as they prepare for federal or foundation level mentored career development awards. Dr. Krutsinger plans to apply for an NIH K01 within the next year, continuing his focus on improving surrogate decision making and supporting surrogate decision makers in the ICU.