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Surrogates' predictions of seriously ill patients' resuscitation preferences.
Arch Fam Med 1995; 4(6):518-23AF

Abstract

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.

Authors+Show Affiliations

Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7773427

Citation

Layde, P M., et al. "Surrogates' Predictions of Seriously Ill Patients' Resuscitation Preferences." Archives of Family Medicine, vol. 4, no. 6, 1995, pp. 518-23.
Layde PM, Beam CA, Broste SK, et al. Surrogates' predictions of seriously ill patients' resuscitation preferences. Arch Fam Med. 1995;4(6):518-23.
Layde, P. M., Beam, C. A., Broste, S. K., Connors, A. F., Desbiens, N., Lynn, J., ... Vidaillet, H. (1995). Surrogates' predictions of seriously ill patients' resuscitation preferences. Archives of Family Medicine, 4(6), pp. 518-23.
Layde PM, et al. Surrogates' Predictions of Seriously Ill Patients' Resuscitation Preferences. Arch Fam Med. 1995;4(6):518-23. PubMed PMID: 7773427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surrogates' predictions of seriously ill patients' resuscitation preferences. A1 - Layde,P M, AU - Beam,C A, AU - Broste,S K, AU - Connors,A F,Jr AU - Desbiens,N, AU - Lynn,J, AU - Phillips,R S, AU - Reding,D, AU - Teno,J, AU - Vidaillet,H, PY - 1995/6/1/pubmed PY - 2001/3/28/medline PY - 1995/6/1/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Professional Patient Relationship KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - 518 EP - 23 JF - Archives of family medicine JO - Arch Fam Med VL - 4 IS - 6 N2 - 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. SN - 1063-3987 UR - https://www.unboundmedicine.com/medline/citation/7773427/Surrogates'_predictions_of_seriously_ill_patients'_resuscitation_preferences_ L2 - https://medlineplus.gov/cpr.html DB - PRIME DP - Unbound Medicine ER -