Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

Comer, Amber; Slaven, James E.; Montz, Annie; Burke, Emily S.; Inger, Lev; Torke, Alexia M.

doi:10.1097/mlr.0000000000000890

Cited by 6 publications

(4 citation statements)

References 16 publications

(11 reference statements)

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“…During the time of this study, Indiana state default health care consent law, was described as having a narrow construction. 16,17 Therefore, our findings may only be transferable to states with similarly restrictive surrogate laws versus those states that allow broader representation. Although the state law used in this study was considered restrictive, the VA was included in this study and the federal law used at the VA is considered broad and inclusive.…”

Section: Discussionmentioning

confidence: 91%

“…Although there is the possibility of sampling bias, the results of this survey are in alignment with prior studies which found a similar low level of knowledge of surrogate health care law. 3,5,16,17 Lastly the residents were asked to recall the education they received during residency about surrogate decision making laws. This response relies on the medical residents' ability to remember incidents of education.…”

Section: Discussionmentioning

confidence: 99%

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Indiana Medical Resident’s Knowledge of Surrogate Decision Making Laws

Bartlett

Fettig

Baenziger

et al. 2021

Community Health Equity Research & Policy

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Introduction During the care of incapacitated patients, physicians, and medical residents discuss treatment options and gain consent to treat through healthcare surrogates. The purpose of this study is to ascertain medical residents’ knowledge of healthcare consent laws, application during clinical practice, and appraise the education residents received regarding surrogate decision making laws. Methods Beginning in February of 2018, 35 of 113 medical residents working with patients within Indiana completed a survey. The survey explored medical residents’ knowledge of health care surrogate consent laws utilized in Indiana hospitals and Veterans Affairs (VA) hospitals via clinical vignettes. Results Only 22.9% of medical residents knew the default state law in Indiana did not have a hierarchy for settling disputes among surrogates. Medical residents correctly identified which family members could participate in medical decisions 86% of the time. Under the Veterans Affairs surrogate law, medical residents correctly identified appropriate family members or friends 50% of the time and incorrectly acknowledged the chief decision makers during a dispute 30% of the time. All medical residents report only having little or some knowledge of surrogate decision making laws with only 43% having remembered receiving surrogate decision making training during their residency. Conclusions These findings demonstrate that medical residents lack understanding of surrogate decision making laws. In order to ensure medical decisions are made by the appropriate surrogates and patient autonomy is upheld, an educational intervention is required to train medical residents about surrogate decision making laws and how they are used in clinical practice.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Indiana Medical Resident’s Knowledge of Surrogate Decision Making Laws

Bartlett

Fettig

Baenziger

et al. 2021

Community Health Equity Research & Policy

Self Cite

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“…One strategy would be providing assistance for such individuals to identify a non-traditional surrogate decision-maker and encourage them to have end-of-life discussions with the identified person. Reporting a similar rate of patient visitation and end-of-life discussion with the patient between traditional (i.e., immediate family members) and non-traditional surrogates (i.e., relatives and friends) in hospital settings, Comer et al (2018) suggested state-specific, surrogate laws should include more non-traditional surrogates to ensure those without a traditional surrogate also has someone to discuss end-of-life care with and speak for the person at the end of life. This may be particularly important to older Blacks/African-Americans, whose caregivers involve much larger, extended family and friends than Whites (American Psychological Association, 2011).…”

Section: Discussionmentioning

confidence: 94%

Willingness to Discuss End-of-Life Care Wishes Among Rural Black/African American Residents of the Alabama Black Belt

et al. 2022

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Willingness for end-of-life discussion and related factors among rural Blacks/African Americans of the Alabama Black Belt have not been well-studied. This study aims to assess their willingness for the discussion and examine its relationship with social determinants of health (SDH) and demographic factors. A cross-sectional survey was conducted with a convenience sampling of 182 participants. Most participants were willing to discuss end-of-life wishes with family (77.1%) or doctors (72.1%). Controlling for demographics, results from binary logistic regressions showed those with hospice awareness were more likely to have willingness for discussion with family ( OR = 10.07, p < .01) and doctors ( OR = 7.23, p < .05). Those who were older (50+) were less likely to have willingness for discussion with doctors ( OR = 0.19, p < .05), whereas those who were more socially isolated were less likely to have willingness for discussion with family ( OR = 0.53, p < .05). Therefore, end-of-life discussion efforts should focus on older, socially isolated individuals and consider hospice awareness.

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“…Nevertheless, nearly 10% of patients select nonrelatives as their healthcare agents (56). Clinicians are often unfamiliar with these laws, which vary considerably from state to state (3,(57)(58)(59). Institutions should manage decisionmaking for unrepresented patients using collaboration between the clinical team and a diverse interprofessional, multidisciplinary committee rather than ad hoc by treating clinicians.…”

Section: Recommendationmentioning

confidence: 99%

Making Medical Treatment Decisions for Unrepresented Patients in the ICU. An Official American Thoracic Society/American Geriatrics Society Policy Statement

Pope¹,

Bennett²,

Carson³

et al. 2020

Am J Respir Crit Care Med

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Background and Rationale: ICU clinicians regularly care for patients who lack capacity, an applicable advance directive, and an available surrogate decision-maker. Although there is no consensus on terminology, we refer to these patients as "unrepresented." There is considerable controversy about how to make treatment decisions for these patients, and there is significant variability in both law and clinical practice. Purpose and Objectives: This multisociety statement provides clinicians and hospital administrators with recommendations for decision-making on behalf of unrepresented patients in the critical care setting. Methods: An interprofessional, multidisciplinary expert committee developed this policy statement by using an iterative consensus process with a diverse working group representing critical care medicine, palliative care, pediatric medicine, nursing, social work, gerontology, geriatrics, patient advocacy, bioethics, philosophy, elder law, and health law. Main Results: The committee designed its policy recommendations to promote five ethical goals: 1) to protect highly vulnerable patients, 2) to demonstrate respect for persons, 3) to provide appropriate medical care, 4) to safeguard against unacceptable discrimination, and 5) to avoid undue influence of competing obligations and conflicting interests. These recommendations also are intended to strike an appropriate balance between excessive and insufficient procedural safeguards. The committee makes the following recommendations: 1) institutions should offer advance care planning to prevent patients at high risk for becoming unrepresented from meeting this definition; 2) institutions should implement strategies to determine whether seemingly unrepresented patients are actually unrepresented, including careful capacity assessments and diligent searches for potential surrogates; 3) institutions should manage decision-making for unrepresented patients using input from a diverse interprofessional, multidisciplinary committee rather than ad hoc by treating clinicians; 4) institutions should use all available information on the patient's preferences and values to guide treatment decisions; 5) institutions should manage decision-making for unrepresented patients using a fair process that comports with procedural due process; 6) institutions should employ this fair process even when state law authorizes procedures with less oversight. Conclusions: This multisociety statement provides guidance for clinicians and hospital administrators on medical decision-making for unrepresented patients in the critical care setting.

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Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

Cited by 6 publications

References 16 publications

Indiana Medical Resident’s Knowledge of Surrogate Decision Making Laws

Indiana Medical Resident’s Knowledge of Surrogate Decision Making Laws

Willingness to Discuss End-of-Life Care Wishes Among Rural Black/African American Residents of the Alabama Black Belt

Making Medical Treatment Decisions for Unrepresented Patients in the ICU. An Official American Thoracic Society/American Geriatrics Society Policy Statement

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