Removing Surrogates' Uncertainty to Reduce Fear and Anxiety After Cardiac Events

Cardiac Arrest Clinical Trial

— RESURFACE  

Official title:

Removing Surrogates' Uncertainty to Reduce Fear and Anxiety After Cardiac Events (RESURFACE): A Randomized Pilot Intervention Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06048068
• Other study ID #: AAAR8497
• Secondary ID: P30AG064198
• Status: Recruiting
• Phase: N/A
• Start date: September 7, 2023
• Est. completion date: May 30, 2024

Study information

• Verified date: September 2023
• Source: Columbia University
• Contact: Sachin Agarwal, MD, MPH
• Phone: 212-305-7236
• Email: sa2512[@]cumc.columbia.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this study is to test the feasibility and acceptability of an informational website to reduce uncertainty, psychological distress, and caregiver burden among close family members of cardiac arrest patients. The investigators hypothesize that participants who receive access to the website will have lower rates of uncertainty, psychological distress, and caregiver burden at 3 months post-hospital discharge compared to participants who receive usual care.

Description:

This study will be an unblinded, two-arm randomized controlled trial that enrolls up to 100 adult surrogates of living cardiac arrest patients hospitalized in the New York Presbyterian hospital system. Participants must be English- or Spanish-speaking and have a device with internet access. Participants will be randomized 2:1 to receive the informational intervention program or usual care (control).

Intervention arm participants will receive the informational intervention in three discrete packages upon study enrollment, movement to the general medical floor, and at one month post-discharge. All participants will be assessed at study enrollment, hospital discharge, and 3 months post-discharge for their illness uncertainty, psychological distress, and caregiver burden. All participants will also wear a GENEActiv sleep monitor to track their sleep for one week following hospital discharge.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: May 30, 2024
• Est. primary completion date: April 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• 18 years of age or older

• Surrogate of a living NewYork Presbyterian Hospital cardiac arrest patient

• English- or Spanish-speaking

• Has a working smartphone, tablet, laptop, or other device with internet access

Exclusion Criteria:

• Any medical and/or psychiatric impairment precluding them from complying with the protocol

• Non-English and non-Spanish speaking

• Lack of internet/device access

• Surrogate of an adult CA patient who passed away

• Cannot be reached for initial contact (3 unsuccessful attempts made in ICU)

• Moved to the in-patient floor before initial contact can be established

Related Conditions & MeSH terms

• Cardiac Arrest
• Cardiovascular Diseases
• Heart Arrest

Intervention

Behavioral:
• Educational Informational Platform
This intervention contains many informational articles for surrogates about cardiac arrest, the subsequent hospitalization, and the emotional journey following cardiac arrest. All articles are available in both English and Spanish.

Locations

Country	Name	City	State
United States	Columbia University Medical Center/New York Presbyterian	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
Columbia University	National Institute on Aging (NIA)

Country where clinical trial is conducted

United States, 

References & Publications (62)

Afifi WA, Felix ED, Afifi TD. The impact of uncertainty and communal coping on mental health following natural disasters. Anxiety Stress Coping. 2012 May;25(3):329-47. doi: 10.1080/10615806.2011.603048. Epub 2011 Aug 1. — View Citation

Agarwal S CJ, Newman M, Abukhadra SL, Rojas D, DeForge C, Tincher I, Wylie J, Anderson ML, Marchionda C. . Prioritizing Interventions to Reduce anxiety and posttraumatic stress Among Racially and Ethnically Diverse family surrogates of Cardiac Arrest Survivors in the United States: A Cross-sectional Survey Study. (Under Review). 2022.

Aggarwal B, Liao M, Christian A, Mosca L. Influence of caregiving on lifestyle and psychosocial risk factors among family members of patients hospitalized with cardiovascular disease. J Gen Intern Med. 2009 Jan;24(1):93-8. doi: 10.1007/s11606-008-0852-1. Epub 2008 Nov 8. — View Citation

Agnes Moors PCE, Klaus R. Scherer, and Nico H. Frijda. Appraisal Theories of Emotion: State of the Art and Future Development. Emotion Review 2013 5:2, 119-124. 2013.

Anderson EC, Carleton RN, Diefenbach M, Han PKJ. The Relationship Between Uncertainty and Affect. Front Psychol. 2019 Nov 12;10:2504. doi: 10.3389/fpsyg.2019.02504. eCollection 2019. — View Citation

Ann-Britt T, Ella D, Johan H, Asa AB. Spouses' experiences of a cardiac arrest at home: an interview study. Eur J Cardiovasc Nurs. 2010 Sep;9(3):161-7. doi: 10.1016/j.ejcnurse.2009.12.005. Epub 2010 Jan 13. — View Citation

Armand S, Wagner MK, Ozenne B, Verbunt J, Sep SJS, Berg SK, Knudsen GM, Stenbaek DS. Acute Traumatic Stress Screening Can Identify Patients and Their Partners at Risk for Posttraumatic Stress Disorder Symptoms After a Cardiac Arrest: A Multicenter Prospective Cohort Study. J Cardiovasc Nurs. 2021 Aug 16. doi: 10.1097/JCN.0000000000000829. Online ahead of print. — View Citation

Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005 May 1;171(9):987-94. doi: 10.1164/rccm.200409-1295OC. Epub 2005 Jan 21. — View Citation

Bailey DE Jr, Barroso J, Muir AJ, Sloane R, Richmond J, McHutchison J, Patel K, Landerman L, Mishel MH. Patients with chronic hepatitis C undergoing watchful waiting: Exploring trajectories of illness uncertainty and fatigue. Res Nurs Health. 2010 Oct;33(5):465-73. doi: 10.1002/nur.20397. — View Citation

Bartley N, Napier CE, Butt Z, Schlub TE, Best MC, Biesecker BB, Ballinger ML, Butow P. Cancer Patient Experience of Uncertainty While Waiting for Genome Sequencing Results. Front Psychol. 2021 Apr 22;12:647502. doi: 10.3389/fpsyg.2021.647502. eCollection 2021. — View Citation

Ben Salah A, DeAngelis BN, al'Absi M. Uncertainty and psychological distress during COVID-19: What about protective factors? Curr Psychol. 2022 May 28:1-8. doi: 10.1007/s12144-022-03244-2. Online ahead of print. — View Citation

Bremer A, Dahlberg K, Sandman L. Experiencing out-of-hospital cardiac arrest: significant others' lifeworld perspective. Qual Health Res. 2009 Oct;19(10):1407-20. doi: 10.1177/1049732309348369. — View Citation

Buhr K, Dugas MJ. The Intolerance of Uncertainty Scale: psychometric properties of the English version. Behav Res Ther. 2002 Aug;40(8):931-45. doi: 10.1016/s0005-7967(01)00092-4. — View Citation

Case R, Stub D, Mazzagatti E, Pryor H, Mion M, Ball J, Cartledge S, Keeble TR, Bray JE, Smith K. The second year of a second chance: Long-term psychosocial outcomes of cardiac arrest survivors and their family. Resuscitation. 2021 Oct;167:274-281. doi: 10.1016/j.resuscitation.2021.06.018. Epub 2021 Jul 6. — View Citation

Chow KM, Chan CW, Chan JC, Choi KK, Siu KY. A feasibility study of a psychoeducational intervention program for gynecological cancer patients. Eur J Oncol Nurs. 2014 Aug;18(4):385-92. doi: 10.1016/j.ejon.2014.03.011. Epub 2014 Apr 30. — View Citation

Chow KM, H Chan CW, Chan JC. Effects of psychoeducational interventions on sexual functioning, quality of life and psychological outcomes in patients with gynaecological cancer: A systematic review. JBI Libr Syst Rev. 2012;10(58):4077-4164. doi: 10.11124/jbisrir-2012-406. — View Citation

Cornelius T, Agarwal S, Garcia O, Chaplin W, Edmondson D, Chang BP. Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department. Acad Emerg Med. 2018 Oct;25(10):1098-1106. doi: 10.1111/acem.13513. — View Citation

Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: postintensive care syndrome-family. Crit Care Med. 2012 Feb;40(2):618-24. doi: 10.1097/CCM.0b013e318236ebf9. — View Citation

De Stefano C, Normand D, Jabre P, Azoulay E, Kentish-Barnes N, Lapostolle F, Baubet T, Reuter PG, Javaud N, Borron SW, Vicaut E, Adnet F. Family Presence during Resuscitation: A Qualitative Analysis from a National Multicenter Randomized Clinical Trial. PLoS One. 2016 Jun 2;11(6):e0156100. doi: 10.1371/journal.pone.0156100. eCollection 2016. — View Citation

Dougherty CM, Pyper GP, Benoliel JQ. Domains of concern of intimate partners of sudden cardiac arrest survivors after ICD implantation. J Cardiovasc Nurs. 2004 Jan-Feb;19(1):21-31. doi: 10.1097/00005082-200401000-00006. — View Citation

Douma MJ, Graham TAD, Ali S, Dainty KN, Bone A, Smith KE, Dennet L, Brindley PG, Kroll T, Frazer K. What are the care needs of families experiencing cardiac arrest?: A survivor and family led scoping review. Resuscitation. 2021 Nov;168:119-141. doi: 10.1016/j.resuscitation.2021.09.019. Epub 2021 Sep 27. — View Citation

Dudas K, Olsson LE, Wolf A, Swedberg K, Taft C, Schaufelberger M, Ekman I. Uncertainty in illness among patients with chronic heart failure is less in person-centred care than in usual care. Eur J Cardiovasc Nurs. 2013 Dec;12(6):521-8. doi: 10.1177/1474515112472270. Epub 2013 Jan 9. — View Citation

Eastwood JA, Doering L, Roper J, Hays RD. Uncertainty and health-related quality of life 1 year after coronary angiography. Am J Crit Care. 2008 May;17(3):232-42; quiz 243. — View Citation

Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, Davig J. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther. 2000 Oct;38(10):1039-53. doi: 10.1016/s0005-7967(99)00132-1. — View Citation

Enhancing recovery in coronary heart disease patients (ENRICHD): study design and methods. The ENRICHD investigators. Am Heart J. 2000 Jan;139(1 Pt 1):1-9. doi: 10.1016/s0002-8703(00)90301-6. — View Citation

GENEActiv. Activinsights Ltd. https://www.activinsights.com/products/geneactiv/. Published 2017. Accessed November 21, 2017.

Grunau B, Dainty K, MacRedmond R, McDonald K, Sasaki A, Sarti AJ, Shemie SD, Cheung A, Gill J. A qualitative exploratory case series of patient and family experiences with ECPR for out-of-hospital cardiac arrest. Resusc Plus. 2021 Apr 28;6:100129. doi: 10.1016/j.resplu.2021.100129. eCollection 2021 Jun. — View Citation

Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nat Rev Neurosci. 2013 Jul;14(7):488-501. doi: 10.1038/nrn3524. — View Citation

Hilton BA. Perceptions of uncertainty: its relevance to life-threatening and chronic illness. Crit Care Nurse. 1992 Feb;12(2):70-3. No abstract available. — View Citation

Johnson CC, Suchyta MR, Darowski ES, Collar EM, Kiehl AL, Van J, Jackson JC, Hopkins RO. Psychological Sequelae in Family Caregivers of Critically III Intensive Care Unit Patients. A Systematic Review. Ann Am Thorac Soc. 2019 Jul;16(7):894-909. doi: 10.1513/AnnalsATS.201808-540SR. — View Citation

Kitko L, McIlvennan CK, Bidwell JT, Dionne-Odom JN, Dunlay SM, Lewis LM, Meadows G, Sattler ELP, Schulz R, Stromberg A; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; Council on Clinical Cardiology; and Council on Lifestyle and Cardiometabolic Health. Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2020 Jun 2;141(22):e864-e878. doi: 10.1161/CIR.0000000000000768. Epub 2020 Apr 30. — View Citation

Lancaster GA, Dodd S, Williamson PR. Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004 May;10(2):307-12. doi: 10.1111/j..2002.384.doc.x. — View Citation

Larsen MK, Mikkelsen R, Budin SH, Lamberg DN, Thrysoe L, Borregaard B. With Fearful Eyes: Exploring Relatives' Experiences With Out-of-Hospital Cardiac Arrest: A Qualitative Study. J Cardiovasc Nurs. 2023 Jan-Feb 01;38(1):E12-E19. doi: 10.1097/JCN.0000000000000893. Epub 2022 Jan 7. — View Citation

Larsson IM, Wallin E, Rubertsson S, Kristoferzon ML. Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia. Eur J Cardiovasc Nurs. 2013 Aug;12(4):353-9. doi: 10.1177/1474515112459618. Epub 2012 Sep 14. — View Citation

Levine EG, Silver B. A pilot study: evaluation of a psychosocial program for women with gynecological cancers. J Psychosoc Oncol. 2007;25(3):75-98. doi: 10.1300/J077v25n03_05. — View Citation

Mion M, Case R, Smith K, Lilja G, Blennow Nordstrom E, Swindell P, Nikolopoulou E, Davis J, Farrell K, Gudde E, Karamasis GV, Davies JR, Toff WD, Abella BS, Keeble TR. Follow-up care after out-of-hospital cardiac arrest: A pilot study of survivors and families' experiences and recommendations. Resusc Plus. 2021 Jul 29;7:100154. doi: 10.1016/j.resplu.2021.100154. eCollection 2021 Sep. — View Citation

Mishel MH, Braden CJ. Finding meaning: antecedents of uncertainty in illness. Nurs Res. 1988 Mar-Apr;37(2):98-103, 127. — View Citation

Mishel MH. The measurement of uncertainty in illness. Nurs Res. 1981 Sep-Oct;30(5):258-63. — View Citation

Mishel MH. Uncertainty in chronic illness. Annu Rev Nurs Res. 1999;17:269-94. — View Citation

Moore CG, Carter RE, Nietert PJ, Stewart PW. Recommendations for planning pilot studies in clinical and translational research. Clin Transl Sci. 2011 Oct;4(5):332-7. doi: 10.1111/j.1752-8062.2011.00347.x. — View Citation

Moulaert VR, van Heugten CM, Winkens B, Bakx WG, de Krom MC, Gorgels TP, Wade DT, Verbunt JA. Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial. Int J Cardiol. 2015 Aug 15;193:8-16. doi: 10.1016/j.ijcard.2015.04.229. Epub 2015 Apr 30. — View Citation

Muehlschlegel S, Perman SM, Elmer J, Haggins A, Teixeira Bailey ND, Huang J, Jansky L, Kirchner J, Kasperek-Wynn R, Lipman PD, Yeatts SD, Fetters MD, Dickert NW, Silbergleit R. The Experiences and Needs of Families of Comatose Patients After Cardiac Arrest and Severe Neurotrauma: The Perspectives of National Key Stakeholders During a National Institutes of Health-Funded Workshop. Crit Care Explor. 2022 Mar 4;4(3):e0648. doi: 10.1097/CCE.0000000000000648. eCollection 2022 Mar. — View Citation

National Center for PTSD. PTSD Checklist for DSM-5 (PCL-5). https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp. Published February 22, 2018. Accessed2018.

Nelson EL, Wenzel LB, Osann K, Dogan-Ates A, Chantana N, Reina-Patton A, Laust AK, Nishimoto KP, Chicz-DeMet A, du Pont N, Monk BJ. Stress, immunity, and cervical cancer: biobehavioral outcomes of a randomized clinical trial [corrected]. Clin Cancer Res. 2008 Apr 1;14(7):2111-8. doi: 10.1158/1078-0432.CCR-07-1632. Erratum In: Clin Cancer Res. 2008 May 1;14(9):2892. — View Citation

Parnia S, Waller DG, Yeates R, Fenwick P. A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation. 2001 Feb;48(2):149-56. doi: 10.1016/s0300-9572(00)00328-2. — View Citation

Penrod J. Refinement of the concept of uncertainty. J Adv Nurs. 2001 Apr;34(2):238-45. doi: 10.1046/j.1365-2648.2001.01750.x. — View Citation

Presciutti A, Newman MM, Grigsby J, Vranceanu AM, Shaffer JA, Perman SM. Associations between posttraumatic stress symptoms and quality of life in cardiac arrest survivors and informal caregivers: A pilot survey study. Resusc Plus. 2021 Feb 4;5:100085. doi: 10.1016/j.resplu.2021.100085. eCollection 2021 Mar. — View Citation

Pusswald G, Fertl E, Faltl M, Auff E. Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment. Resuscitation. 2000 Nov;47(3):241-8. doi: 10.1016/s0300-9572(00)00240-9. — View Citation

Rojas DA, DeForge CE, Abukhadra SL, Farrell L, George M, Agarwal S. Family experiences and health outcomes following a loved ones' hospital discharge or death after cardiac arrest: A scoping review. Resusc Plus. 2023 Mar 3;14:100370. doi: 10.1016/j.resplu.2023.100370. eCollection 2023 Jun. — View Citation

Rosenkilde S, Missel M, Wagner MK, Dichman C, Hermansen AS, Larsen MK, Joshi VL, Zwisler AD, Borregaard B. Caught between competing emotions and tensions while adjusting to a new everyday life: a focus group study with family caregivers of out-of-hospital cardiac arrest survivors. Eur J Cardiovasc Nurs. 2023 Apr 12;22(3):320-327. doi: 10.1093/eurjcn/zvac056. — View Citation

Sawyer KN, Camp-Rogers TR, Kotini-Shah P, Del Rios M, Gossip MR, Moitra VK, Haywood KL, Dougherty CM, Lubitz SA, Rabinstein AA, Rittenberger JC, Callaway CW, Abella BS, Geocadin RG, Kurz MC; American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; Council on Quality of Care and Outcomes Research; and Stroke Council. Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association. Circulation. 2020 Mar 24;141(12):e654-e685. doi: 10.1161/CIR.0000000000000747. Epub 2020 Feb 12. — View Citation

Simons LH, Cunningham S, Catanzaro M. Emotional responses and experiences of wives of men who survive a sudden cardiac death event. Cardiovasc Nurs. 1992 May-Jun;28(3):17-22. No abstract available. — View Citation

St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL; American Heart Association Obesity, Behavior Change, Diabetes, and Nutrition Committees of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2016 Nov 1;134(18):e367-e386. doi: 10.1161/CIR.0000000000000444. Epub 2016 Sep 19. — View Citation

Sweeny K. On the Experience of Awaiting Uncertain News. Current Directions in Psychological Science. 2018;27(4):281-285.

te Lindert BH, Van Someren EJ. Sleep estimates using microelectromechanical systems (MEMS). Sleep. 2013 May 1;36(5):781-9. doi: 10.5665/sleep.2648. — View Citation

van Hees VT, Sabia S, Anderson KN, Denton SJ, Oliver J, Catt M, Abell JG, Kivimaki M, Trenell MI, Singh-Manoux A. A Novel, Open Access Method to Assess Sleep Duration Using a Wrist-Worn Accelerometer. PLoS One. 2015 Nov 16;10(11):e0142533. doi: 10.1371/journal.pone.0142533. eCollection 2015. — View Citation

van Lommel P, van Wees R, Meyers V, Elfferich I. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet. 2001 Dec 15;358(9298):2039-45. doi: 10.1016/S0140-6736(01)07100-8. Erratum In: Lancet 2002 Apr 6;359(9313):1254. — View Citation

van Wijnen HG, Rasquin SM, van Heugten CM, Verbunt JA, Moulaert VR. The impact of cardiac arrest on the long-term wellbeing and caregiver burden of family caregivers: a prospective cohort study. Clin Rehabil. 2017 Sep;31(9):1267-1275. doi: 10.1177/0269215516686155. Epub 2017 Jan 9. — View Citation

Van't Wout Hofland J, Moulaert V, van Heugten C, Verbunt J. Long-term quality of life of caregivers of cardiac arrest survivors and the impact of witnessing a cardiac event of a close relative. Resuscitation. 2018 Jul;128:198-203. doi: 10.1016/j.resuscitation.2018.03.016. Epub 2018 Mar 19. — View Citation

Wachelder EM, Moulaert VR, van Heugten C, Verbunt JA, Bekkers SC, Wade DT. Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest. Resuscitation. 2009 May;80(5):517-22. doi: 10.1016/j.resuscitation.2009.01.020. Epub 2009 Mar 17. — View Citation

Wallin E, Larsson IM, Rubertsson S, Kristoferzon ML. Relatives' experiences of everyday life six months after hypothermia treatment of a significant other's cardiac arrest. J Clin Nurs. 2013 Jun;22(11-12):1639-46. doi: 10.1111/jocn.12112. Epub 2013 Feb 28. — View Citation

Weathers F, Litz B, Keane T, Palmieri P, Marx B, Schnurr P. The PTSD checklist for DSM- 5 (PCL-5) Boston. MA: National Center for PTSD. 2013.

* Note: There are 62 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Intolerance of Uncertainty Scale Score	This 27-item metric measures surrogates' emotional, cognitive, and behavioral responses to ambiguity, uncertainty, and attempts to control the future. Participants will rank their response from a scale of 1 to 5, 1 being 'Strongly Disagree' and 5 being 'Strongly Agree.' The total score will be out of 135.	At study enrollment in the intensive care unit (baseline)
Other	Threat Perception Scale Score	This 7-item scale measures surrogates' self-reported feelings of helplessness or lack of control related to their loved one's cardiac arrest. Participants choose from a range of 1 to 4, 1 being 'Not at all' and 4 being 'Extremely'. The total score is taken out of 28.	At study enrollment in the intensive care unit (baseline)
Other	ENRICHD Social Support Instrument Score	This metric is a 6-item self-reported measure of social support. Participants will be asked to score their answers from 1 to 5, 1 being "None of the time," and 5 being "All of the time." The total score is out of 30.	At hospital discharge (approximately 21 days after baseline)
Other	Systems Usability Scale (SUS) Score	This metric is a 10-item questionnaire measuring perceived usability of the online informational intervention platform by intervention group participants. Participants will be asked to score their answers from a range of 1 to 5, 1 being "Completely disagree," and 5 being "Completely Agree." The total score will be out of 50.	At 3 months post-discharge
Primary	Mishel Uncertainty in Illness Scale Score - Family Member Form	This metric is a 31-item scale measuring surrogates' self-reported uncertainty related to their loved one's cardiac arrest. Participants will be asked to answer from a scale of 1 to 5, 1 being 'Strongly Disagree' and 5 being 'Strongly Agree.' The scale will be scored out of 155.	At study enrollment in the intensive care unit (baseline), at hospital discharge (approximately 21 days after baseline), 3 months post-hospital discharge
Secondary	Post-Traumatic Stress Disorder Checklist (PCL-5) Score	This metric is a 20-item measure of self-reported post-traumatic stress symptoms as defined by the DSM-5. Participants will be asked to score their answer from 0 to 4, 0 being 'Not at all,' and 4 being 'Extremely.' The total score will be out of 80.	At study enrollment in the intensive care unit (baseline), at hospital discharge (approximately 21 days after baseline), 3 months post-hospital discharge
Secondary	Cardiac Anxiety Questionnaire Score - fear subscale	This 8-item metric measures surrogates' self-reported fear of their loved one's cardiac-related stimuli and sensations due to perceived negative consequences. Participants will be asked to rank answers from 1 to 5, 1 being 'Never' and 5 being 'Always.' The total will be out of 40.	At hospital discharge (approximately 21 days after baseline), 3 months post-hospital discharge
Secondary	Zarit Burden Interview 12-item short form score	This 12-item metric measures surrogates' self-reported caregiver burden. Participants will be asked to score their answers from 0 to 4, 0 being "Never," and 4 being "Always." The total score is taken out of 48.	At 3 months post-discharge.