Deferred Decision Making: patients’ reliance on family and physicians for cpr decisions in critical care

Abstract

The aim of this study was to investigate factors associated with seriously ill patients' preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR) = 2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR = 0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients' preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables.

Quality of life concerns and end‐of‐life care preferences of aged persons in long‐term care facilities

“…Probably, planning for the end‐of‐life is uncommon among the older people, as the majority of them believe that the physician has authority with regard to treatment decisions. This is consistent with Kim and Kjervik's (2005) study, which found that regardless of their age, psychological and symptomatic variables, patients preferred to have their physicians and families make treatment decisions for them. In this study, the role of the family was the least important in making treatment decisions.…”

Quality of life concerns and end‐of‐life care preferences of aged persons in long‐term care facilities

“…Probably, planning for the end‐of‐life is uncommon among the older people, as the majority of them believe that the physician has authority with regard to treatment decisions. This is consistent with Kim and Kjervik's (2005) study, which found that regardless of their age, psychological and symptomatic variables, patients preferred to have their physicians and families make treatment decisions for them. In this study, the role of the family was the least important in making treatment decisions.…”

Between Hope and Harm: A Meta‐Synthesis of Family Decision‐Making Agonies in ECMO Initiation Crossroads

“…We found that family members involved in ECMO initiation decisions often encounter a complex array of challenges, including insufficient understanding of medical information, time‐pressured decision‐making, substantial financial burden and profound emotional and ethical dilemmas. These findings are consistent with prior research on decision‐making in critical care settings [17–19]. For instance, in end‐of‐life cancer care, decision fatigue commonly arises due to the complexity of medical information and prognostic uncertainty, making it difficult for family members to process large volumes of clinical data [20].…”

Readiness of Chinese frail old age home residents towards end‐of‐life care decision making

“…This echoes the analysis in the SUPPORT, SUPPORT II and HELP studies, which showed that many older people wanted their family and their physicians to make resuscitation decisions for them (Puchalski et al. 2000, Kim & Kjervik 2005). If this were their choice, the value of advance care planning for this group of residents would mainly be getting them to designate a spokesperson for their health care decision and make their ‘preferences’ known to their significant others or caregivers to prevent unnecessary disputes over treatment decisions.…”

Quality of life concerns and end‐of‐life care preferences of aged persons in long‐term care facilities

“…Probably, planning for the end‐of‐life is uncommon among the older people, as the majority of them believe that the physician has authority with regard to treatment decisions. This is consistent with Kim and Kjervik's (2005) study, which found that regardless of their age, psychological and symptomatic variables, patients preferred to have their physicians and families make treatment decisions for them. In this study, the role of the family was the least important in making treatment decisions.…”

Between Hope and Harm: A Meta‐Synthesis of Family Decision‐Making Agonies in ECMO Initiation Crossroads

“…We found that family members involved in ECMO initiation decisions often encounter a complex array of challenges, including insufficient understanding of medical information, time‐pressured decision‐making, substantial financial burden and profound emotional and ethical dilemmas. These findings are consistent with prior research on decision‐making in critical care settings [17–19]. For instance, in end‐of‐life cancer care, decision fatigue commonly arises due to the complexity of medical information and prognostic uncertainty, making it difficult for family members to process large volumes of clinical data [20].…”

Readiness of Chinese frail old age home residents towards end‐of‐life care decision making

“…This echoes the analysis in the SUPPORT, SUPPORT II and HELP studies, which showed that many older people wanted their family and their physicians to make resuscitation decisions for them (Puchalski et al. 2000, Kim & Kjervik 2005). If this were their choice, the value of advance care planning for this group of residents would mainly be getting them to designate a spokesperson for their health care decision and make their ‘preferences’ known to their significant others or caregivers to prevent unnecessary disputes over treatment decisions.…”

Quality of life concerns and end‐of‐life care preferences of aged persons in long‐term care facilities

“…Probably, planning for the end‐of‐life is uncommon among the older people, as the majority of them believe that the physician has authority with regard to treatment decisions. This is consistent with Kim and Kjervik's (2005) study, which found that regardless of their age, psychological and symptomatic variables, patients preferred to have their physicians and families make treatment decisions for them. In this study, the role of the family was the least important in making treatment decisions.…”

Between Hope and Harm: A Meta‐Synthesis of Family Decision‐Making Agonies in ECMO Initiation Crossroads

“…We found that family members involved in ECMO initiation decisions often encounter a complex array of challenges, including insufficient understanding of medical information, time‐pressured decision‐making, substantial financial burden and profound emotional and ethical dilemmas. These findings are consistent with prior research on decision‐making in critical care settings [17–19]. For instance, in end‐of‐life cancer care, decision fatigue commonly arises due to the complexity of medical information and prognostic uncertainty, making it difficult for family members to process large volumes of clinical data [20].…”

Readiness of Chinese frail old age home residents towards end‐of‐life care decision making

“…This echoes the analysis in the SUPPORT, SUPPORT II and HELP studies, which showed that many older people wanted their family and their physicians to make resuscitation decisions for them (Puchalski et al. 2000, Kim & Kjervik 2005). If this were their choice, the value of advance care planning for this group of residents would mainly be getting them to designate a spokesperson for their health care decision and make their ‘preferences’ known to their significant others or caregivers to prevent unnecessary disputes over treatment decisions.…”