Improving Decision Making for Patients With Prolonged Mechanical Ventilation

Inclusion Criteria (Patient characteristics required for surrogate inclusion) * age ≥18 * ≥10 days of mechanical ventilation interrupted by \<96 continuous hours of unassisted breathing (including invasive and non-invasive ventilation) * no anticipation of imminent (24 hours) death or extubation by the attending. Exclusion Criteria (Patient characteristics that will exclude surrogates from study enrollment): * possession of decisional capacity * no identifiable surrogate, surrogate is unavailable for study procedures such as interviews * imminent organ transplantation * chronic neuromuscular disease * physician refuses permission to approach family and/or patient for consent * admission for severe burns * admission for high cervical spine injury * ventilation for \>21 days. Inclusion criteria for surrogate decision makers: * age ≥18 * self-identified as participating directly in health care decision making for the incapable patient under relevant state law Exclusion criteria for surrogate decision makers: * do not personally know the patient * need translation assistance because of poor English fluency (the decision aid has not been validated in other languages) * history of clinically important neurological disorder (e.g., dementia) * patient dies after meeting inclusion criteria but before surrogates provide consent Physician and nurse inclusion criteria: * ICU attending or fellow (physicians) at the time of surrogate enrollment * bedside ICU nurse present at the time of surrogate enrollment