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Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences?
Med Decis Making 2008 Jul-Aug; 28(4):524-31MD

Abstract

BACKGROUND

When a patient is too incapacitated to make important end-of-life decisions, doctors may ask a preappointed surrogate to predict the patient's preferences and make decisions on the patient's behalf. The current study investigates whether surrogates project their own views onto what they predict the patients' preferences are.

METHODS

Using data from seriously ill patients and their surrogates, the authors created a "projection'' variable that addresses the following question: When surrogates are asked to predict a patient's end-of-life preferences, do they mistakenly replace this prediction with what they would want the patient to do? The authors examined the 144 patient-surrogate pairs in which surrogates inaccurately predicted patients' CPR (cardiopulmonary resuscitation) v. DNR (do not resuscitate) decisions and the 294 pairs in which surrogates inaccurately predicted patients' extend life v. relieve pain preferences. Among these patient-surrogate pairs, the authors determined the extent to which surrogates' wishes for the patient matched their incorrect predictions of what the patient wanted.

RESULTS

Of the patient-surrogate pairs who disagreed on CPR v. DNR and extend life v. relieve pain preferences, 62.5% and 88.4% of surrogates demonstrated projection for CPR v. DNR decisions and extend life v. relieve pain preferences, respectively. Age-related and demographic variables did not predict cases in which projection did and did not occur.

CONCLUSION

When surrogates inaccurately predict the CPR v. DNR and extend life v. relieve pain preferences of seriously ill, hospitalized loved ones, surrogates' prediction errors often represent surrogates' own wishes for the patient.

Authors+Show Affiliations

Department of Psychology, The Ohio State University Columbus, OH 43210-1222, USA. marks.99@osu.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18566485

Citation

Marks, Melissa A Z., and Hal R. Arkes. "Patient and Surrogate Disagreement in End-of-life Decisions: Can Surrogates Accurately Predict Patients' Preferences?" Medical Decision Making : an International Journal of the Society for Medical Decision Making, vol. 28, no. 4, 2008, pp. 524-31.
Marks MA, Arkes HR. Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences? Med Decis Making. 2008;28(4):524-31.
Marks, M. A., & Arkes, H. R. (2008). Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences? Medical Decision Making : an International Journal of the Society for Medical Decision Making, 28(4), pp. 524-31. doi:10.1177/0272989X08315244.
Marks MA, Arkes HR. Patient and Surrogate Disagreement in End-of-life Decisions: Can Surrogates Accurately Predict Patients' Preferences. Med Decis Making. 2008;28(4):524-31. PubMed PMID: 18566485.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences? AU - Marks,Melissa A Z, AU - Arkes,Hal R, Y1 - 2008/06/19/ PY - 2008/6/21/pubmed PY - 2008/11/14/medline PY - 2008/6/21/entrez SP - 524 EP - 31 JF - Medical decision making : an international journal of the Society for Medical Decision Making JO - Med Decis Making VL - 28 IS - 4 N2 - BACKGROUND: When a patient is too incapacitated to make important end-of-life decisions, doctors may ask a preappointed surrogate to predict the patient's preferences and make decisions on the patient's behalf. The current study investigates whether surrogates project their own views onto what they predict the patients' preferences are. METHODS: Using data from seriously ill patients and their surrogates, the authors created a "projection'' variable that addresses the following question: When surrogates are asked to predict a patient's end-of-life preferences, do they mistakenly replace this prediction with what they would want the patient to do? The authors examined the 144 patient-surrogate pairs in which surrogates inaccurately predicted patients' CPR (cardiopulmonary resuscitation) v. DNR (do not resuscitate) decisions and the 294 pairs in which surrogates inaccurately predicted patients' extend life v. relieve pain preferences. Among these patient-surrogate pairs, the authors determined the extent to which surrogates' wishes for the patient matched their incorrect predictions of what the patient wanted. RESULTS: Of the patient-surrogate pairs who disagreed on CPR v. DNR and extend life v. relieve pain preferences, 62.5% and 88.4% of surrogates demonstrated projection for CPR v. DNR decisions and extend life v. relieve pain preferences, respectively. Age-related and demographic variables did not predict cases in which projection did and did not occur. CONCLUSION: When surrogates inaccurately predict the CPR v. DNR and extend life v. relieve pain preferences of seriously ill, hospitalized loved ones, surrogates' prediction errors often represent surrogates' own wishes for the patient. SN - 0272-989X UR - https://www.unboundmedicine.com/medline/citation/18566485/Patient_and_surrogate_disagreement_in_end_of_life_decisions:_can_surrogates_accurately_predict_patients'_preferences L2 - http://journals.sagepub.com/doi/full/10.1177/0272989X08315244?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -