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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.

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Acknowledgements

The authors would like to thank Greg Sachs, MD, and Larry Casalino, MD, PhD, for guidance on survey development, Miguel Leal, MD, and Harry Piotrowski, MS, for assistance with subject recruitment. Thanks to Diane Lauderdale, PhD, for assistance with data analysis. Thanks to Danit Kaya, AB, for assistance with data collection.

Funding

Dr. Alexander is a Robert Wood Johnson Faculty Scholar and is also supported by a career development award from the Agency for Healthcare Research and Quality (K08 HS15699–01A1). Dr. Torke was supported by a training grant from the Health Resources and Services Administration, D55HP03365–02–00, and is currently supported by a Hartford Geriatric Health Research Outcomes Scholars Award. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Indiana University Center for Aging Research, Indianapolis, IN, USA

    Alexia M. Torke MD, MS

  2. The Regenstrief Institute, Indiana University, HITS Building Suite 2000, 410 W. 10th St, Indianapolis, IN, 46202, USA

    Alexia M. Torke MD, MS

  3. Fairbanks Center for Medical Ethics, Clarian Health System, Indianapolis, IN, USA

    Alexia M. Torke MD, MS

  4. MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Mark Siegler MD & G. Caleb Alexander MD, MS

  5. Department of Internal Medicine, University of Chicago Hospitals, Chicago, IL, USA

    Mark Siegler MD, Rachael M. Moloney BA & G. Caleb Alexander MD, MS

  6. Department of Internal Medicine, West Suburban Hospital, Oak Park, IL, USA

    Anna Abalos MD

  7. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA

    G. Caleb Alexander MD, MS

Authors
  1. Alexia M. Torke MD, MS
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  2. Mark Siegler MD
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  3. Anna Abalos MD
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  4. Rachael M. Moloney BA
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  5. G. Caleb Alexander MD, MS
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Corresponding author

Correspondence to Alexia M. Torke MD, MS.

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ESM 1.

Surrogate Decision Making: Physician Survey (DOC 138 KB)

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Torke, A.M., Siegler, M., Abalos, A. et al. Physicians’ Experience with Surrogate Decision Making for Hospitalized Adults. J GEN INTERN MED 24, 1023–1028 (2009). https://doi.org/10.1007/s11606-009-1065-y

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  • DOI: https://doi.org/10.1007/s11606-009-1065-y

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