Projection in surrogate decisions about life-sustaining medical treatments.

Fagerlin, Angela; Ditto, Peter H.; Danks, Joseph H.; Houts, Renate; Smucker, William D.

doi:10.1037/0278-6133.20.3.166

Cited by 237 publications

(185 citation statements)

References 40 publications

(63 reference statements)

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“…17,18,21,[25][26][27][28][29][30][31][32] In such studies, individuals are asked what they would want for themselves in particular circumstances. Their loved ones or designated proxies are then asked to predict what the patient would have wanted.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

2008

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Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

2008

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“…From yet another study, Lerouge and Warlop (2006) concluded that student couples had rather low prediction accuracy when forecasting their partner's bedroom furniture preferences. Fagerlin, Ditto, Danks, Houts, and Smucker (2001) reported that adult children's forecasts of whether their parents would want life-sustaining medical treatment were between 64% and 72% accurate across scenarios. As there were only two alternatives to choose from, chance level was 50%.…”

Section: Prediction Accuracymentioning

confidence: 99%

Predicting children's meal preferences: How much do parents know?

2008

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We investigate how accurate parents are at predicting their children's meal preferences and what cues best describe parents' predictions. In Study 1, 30 parents predicted their children's school lunch choices from actual school menus. Parents' prediction accuracy matched the stability of children's meal choices (assessed in a 4-month retest), implying that accuracy was as high as can be expected. Parents appeared to make their predictions by using specific knowledge about their child's likes and by projecting their own preferences. In Study 2, we asked 58 parents to predict their children's preferences for 30 randomly drawn school meals, and compared them to the children's actual preferences. Again, parents showed high prediction accuracy and predicted the lunches their children liked correctly more often than the disliked ones. Overall, parents' accuracy in predicting their children's food preferences was as good as or better than found in previous preference prediction studies that used less ecologically relevant task domains. r

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“…A review of the 16 studies of surrogate accuracy published between 1966 and 2005 found that overall, surrogates responding to a hypothetical decisionmaking scenario were inaccurate 32 percent of the time (Shalowitz, Garrett-Mayer, and Wendler 2006). Surrogates often presume (erroneously) that the patient's preferences are identical to their own: Surrogates' own preferences account for more of the variance in their decisions than do the patients' actual preferences (Bar-Tal, Barnoy, and Zisser 2005;Fagerlin et al 2001;Pruchno et al 2005).…”

mentioning

confidence: 99%

Do Older Adults Know Their Spouses' End-of-Life Treatment Preferences?

Moorman¹,

Hauser²,

Carr³

2009

ICPSR Data Holdings

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When terminally ill patients become mentally incapacitated, the patient's surrogate often makes treatment decisions in collaboration with health care providers. We examine how surrogates' errors in reporting their spouse's preferences are affected by their gender, status as durable power of attorney for health care (DPAHC), whether the surrogate and spouse held discussions about end-of-life preferences, and the spouse's health status. We apply structural equation models to data from 2,750 married couples in their mid 60s who participated in the 2004 wave of the Wisconsin Longitudinal Study. Surrogates reported their spouse's preferences incorrectly 13 and 26 percent of the time in end-of-life scenarios involving cognitive impairment and physical pain, respectively. Surrogates projected their own preferences onto the spouse. Similar patterns emerged regardless of surrogate gender, surrogate status as DPAHC, marital discussions about end-of-life, or spousal health status. We discuss implications for the process of surrogate decision-making and for future research.As recently as 1960, nearly all physicians were opposed to telling their patients that they had terminal cancer, because they believed that the knowledge would have shattering psychological effects (Oken 1961). Subsequent psychosocial research showed that the awareness that one is dying does not emotionally harm a patient (Kübler-Ross 1969). Physician attitudes evolved such that the standard for care is now full disclosure and collaboration among patients, health care providers, and surrogate decision-makers in cases where the patient is unable to convey his or her own treatment preferences (Brody 1997;Novack et al. 1979;Snyder and Leffler 2005). Changes in physician attitudes have occurred alongside policy changes: In 1990, Congress passed the Patient Self-Determination Act (PSDA) to ensure that dying people have a greater say in their care. Under this law, federally funded health care providers are required to give patients information that helps them to execute a living will and to legally appoint a surrogate, known as a durable power of attorney for health care (DPAHC), to oversee their care in the event of decisional incapacitation.A concern of patients and health care providers is that surrogates accurately convey the patient's wishes. An effective surrogate, according to bioethicists, is someone who can apply the standard of substituted judgment (President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research 1983). Substituted judgment occurs when the surrogate makes the medical decision that the patient would have made if he or she (Shalowitz, Garrett-Mayer, and Wendler 2006). Surrogates often presume (erroneously) that the patient's preferences are identical to their own: Surrogates' own preferences account for more of the variance in their decisions than do the patients' actual preferences (Bar-Tal, Barnoy, and Zisser 2005;Fagerlin et al. 2001;Pruchno et al. 2005). Study AimsOur primary goal ...

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Projection in surrogate decisions about life-sustaining medical treatments.

Cited by 237 publications

References 40 publications

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

Predicting children's meal preferences: How much do parents know?

Do Older Adults Know Their Spouses' End-of-Life Treatment Preferences?

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