Surrogates' predictions of seriously ill patients' resuscitation preferences
P. M. Layde, C. A. Beam, S. K. Broste, A. F. Connors Jr, N. Desbiens, J. Lynn, R. S. Phillips, D. Reding, J. Teno, H. Vidaillet and al. et
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, USA.
BACKGROUND: Seriously or terminally ill patients are frequently
incapacitated and unable to express their preferences regarding
cardiopulmonary resuscitation (CPR). In this situation, family members or
other surrogate decision makers are often asked whether they believe the
patient would want to be resuscitated. We evaluated the concordance of
patient CPR preferences and surrogate perceptions of the patient
preferences in the Study to Understand Prognoses and Preferences for
Outcomes and Risks of Treatments (SUPPORT), a large, multicenter study of
seriously ill hospitalized patients. METHODS: We compared patient
preferences and surrogate perceptions in 1226 pairings in which both
patient and surrogate responded to CPR decision questions. We also examined
factors that might influence patient-surrogate concordance. RESULTS:
Twenty-nine percent of patients with paired data did not want to be
resuscitated; 26% of surrogates did not believe the patient they
represented would want to be resuscitated. Within pairs, the overall exact
agreement with respect to CPR decisions was 74%. For patients favoring CPR,
only 16% of the surrogates misconstrued the patient's wishes. For patients
who did not want to be resuscitated, however, 50% of the surrogates did not
reflect the patient's wishes. If patients reported telling surrogates their
CPR preference, concordance was significantly improved if the surrogate
believed the patient did not want to be resuscitated and was significantly
worsened if the surrogate believed the patient wanted CPR. This finding is
likely an artifact of patients being more likely to report their preference
to surrogates if that preference was not to be resuscitated. CONCLUSIONS:
Surrogates' perceptions of patient CPR preferences are often inaccurate,
particularly for those patients who do not want to be resuscitated. Methods
to improve communication between patients and surrogates on CPR preferences
should be developed and evaluated.
Patient and Surrogate Disagreement in End-of-Life Decisions: Can Surrogates Accurately Predict Patients' Preferences?
Marks and Arkes
Med Decis Making 2008;28:524-531.
ABSTRACT
Life Support for Patients without a Surrogate Decision Maker: Who Decides?
White et al.
ANN INTERN MED 2007;147:34-40.
ABSTRACT
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Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology
Alexander et al.
Circulation 2007;115:2570-2589.
ABSTRACT
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The accuracy of surrogate decision makers: a systematic review.
Shalowitz et al.
Arch Intern Med 2006;166:493-497.
ABSTRACT
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Micromanaging Death: Process Preferences, Values, and Goals in End-of-Life Medical Decision Making
Hawkins et al.
Gerontologist 2005;45:107-117.
ABSTRACT
| FULL TEXT
End-of-life care: Perspectives of family members of deceased patients
Marco et al.
AM J HOSP PALLIAT CARE 2005;22:26-31.
ABSTRACT
Relatives' knowledge of decision making in intensive care
Booth et al.
J. Med. Ethics 2004;30:459-461.
ABSTRACT
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Determining resuscitation preferences of elderly inpatients: a review of the literature
Frank et al.
CMAJ 2003;169:795-799.
ABSTRACT
| FULL TEXT
The Use of Advance Directives in End-of-life Decision Making: Problems and Possibilities
FAGERLIN et al.
American Behavioral Scientist 2002;46:268-283.
ABSTRACT
Research Design in End-of-Life Research: State of Science
George
Gerontologist 2002;42:86-98.
ABSTRACT
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"Choice" in End-of-Life Decision Making: Researching Fact or Fiction?
Drought and Koenig
Gerontologist 2002;42:114-128.
ABSTRACT
| FULL TEXT
The Illusion of Patient Choice in End-of-Life Decisions
Sullivan
AJGP 2002;10:365-372.
ABSTRACT
| FULL TEXT
Advance Directives as Acts of Communication: A Randomized Controlled Trial
Ditto et al.
Arch Intern Med 2001;161:421-430.
ABSTRACT
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Accuracy of Primary Care and Hospital-Based Physicians' Predictions of Elderly Outpatients' Treatment Preferences With and Without Advance Directives
Coppola et al.
Arch Intern Med 2001;161:431-440.
ABSTRACT
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Modal Preferences Predict Elderly Patients' Life-sustaining Treatment Choices as Well as Patients' Chosen Surrogates Do
Smucker et al.
Med Decis Making 2000;20:271-280.
ABSTRACT
Oregon's Physician-Assisted Suicide Legislation: Troubling Issues for Families
Tilden and Lee
Journal of Family Nursing 1997;3:120-129.
ABSTRACT
CAN SURROGATES PREDICT PATIENTS' WISHES FOR CPR?
JWatch General 1995;1995:7-7.
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