, Volume 24, Issue 9, pp 1023-1028
Date: 25 Jul 2009

Physicians’ Experience with Surrogate Decision Making for Hospitalized Adults

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Abstract

Background

Hospitalized patients frequently lack decision-making ability, yet little is known about physicians’ approaches to surrogate decision making.

Objective

To describe physicians’ experiences with surrogate communication and decision making for hospitalized adults.

Design

Cross-sectional written survey.

Participants

Two hundred eighty-one physicians who recently cared for adult inpatients in one academic and two community hospitals.

Measurements

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.

Results

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).

Conclusion

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.

Prior Presentation

This paper was presented in part at the National Meeting of the Society of General Internal Medicine, April 2007.