Factors predicting collaborative willingness of surrogates making medical decisions on the Physician Order for Scope of Treatment (POST)

Spalding, Rachael; Edelstein, Barry A.

doi:10.1080/13607863.2019.1660854

Cited by 4 publications

(7 citation statements)

References 45 publications

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“…For instance, individuals who are relatively less familiar with medical treatments, terminology, and diagnoses may not distinguish how certain scenarios and choices present greater risks or potential complications. Surrogates may be called to make decisions regarding a variety of interventions, and medical decision‐making can vary depending on the characteristics of specific decisions (Spalding & Edelstein, in press). For instance, Portanova, Irvine, Yi, and colleagues (2015) suggest that individuals may feel more comfortable with decisions about CPR due to the increased familiarity that results from the frequent portrayal of CPR interventions in mainstream media.…”

Section: Resultsmentioning

confidence: 99%

Accuracy in Surrogate End‐of‐Life Medical Decision‐Making: A Critical Review

Spalding

2020

Applied Psych Health & Well

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Background Increasing age is accompanied by a greater need for medical decisions, due in part to age‐related increases in chronic disease and disability. In later life, medical decisions about end‐of‐life care in particular are likely. However, a significant percentage of these decisions are made by surrogate decision‐makers. “Surrogates” are most often instructed to use the substituted judgment standard and make decisions that patients would choose if they were able. Whether surrogates make decisions that adequately match patients’ preferences is a concern. Surrogates are generally poor predictors of patient preferences (Shalowitz et al., 2006). However, no critical review of this literature has yet been published. Method A critical review was conducted to summarise and provide a methodological critique of 25 studies. Results These studies generally concur that patient–surrogate agreement on medical decisions is poor. However, this conclusion is qualified by inconsistencies in methodological quality and the potentially limited generalisability of these findings. Conclusions Clinical research incorporating standardised hypothetical decision‐making protocols, as well as triangulated data collection methods, would bolster confidence in future findings. Investigations prioritising the surrogate decision‐making process, rather than solely the decisional outcome, could better identify ways to improve the decision‐making process for incapacitated patients.

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Section: Resultsmentioning

confidence: 99%

Accuracy in Surrogate End‐of‐Life Medical Decision‐Making: A Critical Review

Spalding

2020

Applied Psych Health & Well

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“…Specifically, the predictive model was significant for decisions regarding the provision of ventilation, dialysis treatment, and cardiac bypass surgery. This finding aligns with previous work (Spalding & Edelstein, 2020) reflecting how treatment options may differentially evoke certain decision-making approaches by surrogates, in terms of their desire to collaborate with patients' physicians and assume full responsibility for decisions. These differences may be due to the fact that presented treatments differ in the amount of risk they involve, and the extent to which such risk is considered worthwhile in the context of the decision (Sitkin & Weingart, 1995).…”

Section: Variables Related To Accuracy On Individual Decision Vignettessupporting

confidence: 89%

“…Variables were grouped into two main categories: intrapersonal characteristics of surrogates themselves (including demographic features of age, race/ethnicity, education level, and type of relationship between patient and surrogate), and interpersonal variables operating between surrogates and other individuals who may be involved in the decision-making process. Furthermore, in light of evidence that surrogates' decision-making preferences and behaviors can vary based on the type of decision being made (Johnson et al, 2011;Spalding & Edelstein, 2020), this study also investigated whether the variables that predict accuracy differ across the decision vignettes. Given the relative dearth of research in this area, the current study was broad and exploratory in scope.…”

Section: Statement Of the Problemmentioning

confidence: 99%

“…In light of evidence that surrogates' approaches to decision making vary based on the type of treatment decision being made (Spalding & Edelstein, 2020), accuracy was also examined for each decision vignette individually. Patient-surrogate agreement was lowest for the decision concerning whether to provide ventilation, while it was highest for the decision regarding coronary bypass surgery (see Table 3).…”

Section: Surrogates' Accuracy On Decision Vignettesmentioning

confidence: 99%

“…These differences may be due to the fact that presented treatments differ in the amount of risk they involve, and the extent to which such risk is considered worthwhile in the context of the decision (Sitkin & Weingart, 1995). For instance, when making decisions about treatments that confer more immediate and substantial risks (e.g., CPR, which presents associated risks of broken ribs and punctured lungs, but which will likely result in immediate death if not provided), the degree of confidence a surrogate has in their decision-making ability is associated with the extent to which they desire collaboration with providers (Spalding & Edelstein, 2020).…”

Section: Variables Related To Accuracy On Individual Decision Vignettesmentioning

confidence: 99%

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Why Are They Wrong? Exploring Surrogates’ Accuracy When Predicting Patient Treatment Preferences

Spalding¹

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Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic

Spalding

Edelstein

2022

Patient Education and Counseling

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Objective Surrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates’ characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates’ accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient. Methods 154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer. Results When taken all together in a predictive model, the variables significantly predicted surrogatesʼ accuracy, F (6) = 3.03, R 2 = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R 2 = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions. Conclusions Consistent with prior research, this study found that surrogates’ characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions. Practice implications These findings can inform development of decision-making interventions to improve surrogates’ accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.

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Factors predicting collaborative willingness of surrogates making medical decisions on the Physician Order for Scope of Treatment (POST)

Cited by 4 publications

References 45 publications

Accuracy in Surrogate End‐of‐Life Medical Decision‐Making: A Critical Review

Accuracy in Surrogate End‐of‐Life Medical Decision‐Making: A Critical Review

Why Are They Wrong? Exploring Surrogates’ Accuracy When Predicting Patient Treatment Preferences

Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic

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