Physicians’ Experience with Surrogate Decision Making for Hospitalized Adults
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Hospitalized patients frequently lack decision-making ability, yet little is known about physicians’ approaches to surrogate decision making.
To describe physicians’ experiences with surrogate communication and decision making for hospitalized adults.
Cross-sectional written survey.
Two hundred eighty-one physicians who recently cared for adult inpatients in one academic and two community hospitals.
Key features of physicians’ most recent surrogate decision-making experience, including the nature of the decision, the physician’s reaction, physician-surrogate communication and physician-surrogate agreement about the best course of action.
Nearly three fourths of physicians (73%, n = 206) had made a major decision with a surrogate during the past month. Although nearly all patients (90%) had a surrogate, physicians reported trouble contacting the surrogate in 21% of cases. Conflict was rare (5%), and a majority of physicians agreed with surrogates about the medical facts (77%), prognosis (72%) and best course of action (65%). After adjustment for patient, physician and decision characteristics, agreement about the best course of action was more common among surrogates for older patients [prevalence ratio (PR) = 1.17 for each decade; 95% confidence interval (CI) 1.02–1.31], ICU patients (PR = 1.40; CI 1.14–1.51) and patients who had previously discussed their wishes (PR = 1.60; CI 1.30–1.76), and less common when surrogates were difficult to contact (PR = 0.59; CI 0.29–0.92) or when the physician self-identified as Asian (PR = 0.60; CI 0.30–0.94).
Surrogate decision making is common among hospitalized adults. Physician-surrogate decision making may be enhanced if patients discuss their preferences in advance and if physician contact with surrogate decision makers is facilitated.
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- Physicians’ Experience with Surrogate Decision Making for Hospitalized Adults
Journal of General Internal Medicine
Volume 24, Issue 9 , pp 1023-1028
- Cover Date
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- decision making
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- Author Affiliations
- 1. Indiana University Center for Aging Research, Indianapolis, IN, USA
- 2. The Regenstrief Institute, Indiana University, HITS Building Suite 2000, 410 W. 10th St, Indianapolis, IN, 46202, USA
- 3. Fairbanks Center for Medical Ethics, Clarian Health System, Indianapolis, IN, USA
- 4. MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
- 5. Department of Internal Medicine, University of Chicago Hospitals, Chicago, IL, USA
- 6. Department of Internal Medicine, West Suburban Hospital, Oak Park, IL, USA
- 7. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA