Journal of General Internal Medicine

, Volume 24, Issue 9, pp 1023–1028

Physicians’ Experience with Surrogate Decision Making for Hospitalized Adults

  • Alexia M. Torke
  • Mark Siegler
  • Anna Abalos
  • Rachael M. Moloney
  • G. Caleb Alexander
Original Article

DOI: 10.1007/s11606-009-1065-y

Cite this article as:
Torke, A.M., Siegler, M., Abalos, A. et al. J GEN INTERN MED (2009) 24: 1023. doi:10.1007/s11606-009-1065-y



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.


decision making communication proxy ethics 

Supplementary material

11606_2009_1065_MOESM1_ESM.doc (138 kb)
ESM 1.Surrogate Decision Making: Physician Survey (DOC 138 KB)

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Alexia M. Torke
    • 1
    • 2
    • 3
  • Mark Siegler
    • 4
    • 5
  • Anna Abalos
    • 6
  • Rachael M. Moloney
    • 5
  • G. Caleb Alexander
    • 4
    • 5
    • 7
  1. 1.Indiana University Center for Aging ResearchIndianapolisUSA
  2. 2.The Regenstrief InstituteIndiana UniversityIndianapolisUSA
  3. 3.Fairbanks Center for Medical EthicsClarian Health SystemIndianapolisUSA
  4. 4.MacLean Center for Clinical Medical EthicsThe University of ChicagoChicagoUSA
  5. 5.Department of Internal MedicineUniversity of Chicago HospitalsChicagoUSA
  6. 6.Department of Internal MedicineWest Suburban HospitalOak ParkUSA
  7. 7.Center for Health and the Social SciencesUniversity of ChicagoChicagoUSA

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