Substituted Judgment

Perkins, Henry S.; Cortez, Josie D.; Hazuda, Helen P.

doi:10.1007/s11606-008-0839-y

Cited by 3 publications

(3 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that EA men may be more family focused than ME men and is consistent with the prevalence of familism in East Asia, 16,17,36 studies showing a stronger familism orientation in Christian/Philippines-educated than Muslim/ Saudi Arabia-educated respondents in relation to organ donation, 29 and studies showing culture dependency of end-of-life preferences. 21,22,37 However, although Q-methodology identified relatively familism-influenced models in all EA viewpoints, there were also a relatively familism-influenced model in the ME S-viewpoint and a relatively family burden-influenced model in the ME Pviewpoint. Furthermore, there were a relatively family non-financial burden-uninfluenced model and a relatively family financial needs-uninfluenced model in the EA N-viewpoint, demonstrating a clear overlap between the 2 cultures.…”

Section: Comparing Middle Eastern and East Asian Menmentioning

confidence: 88%

Importance Hierarchy of Surrogate Medical Decision Making Determinants: A Q-Methodology Study in Middle Eastern and East Asian Men

2020

View full text Add to dashboard Cite

Background Factors other than patient’s preference may influence surrogate medical decision making in a culture- and viewpoint-dependent way. We explored the importance hierarchy of potential surrogate medical decision making determinants to Middle-Eastern (ME) and East-Asian (EA) men according to their norm-perception (N-viewpoint), preference as patients (P-viewpoint), and preference as surrogate decision-makers (S-viewpoint). Methods Each respondent (120 ME, 120 EA) sorted 28 items reflecting potential determinants into a fixed distribution of importance hierarchy according to the three viewpoints. Latent decision making models were explored by by-person factor analysis (Q-methodology). Results Six models were identified for each ME and EA viewpoint (total 36). Patient’s health-related, patient’s preference-related, and society’s interests-related determinants were strongly embraced in 34, 3, and zero models and strongly discounted in 2, 5, and 21 models, respectively. Patient’s religious/spiritual belief was strongly embraced in 6 EA models compared to 2 ME models and strongly discounted in 2 EA models compared to 5 ME models. Further, family-centric and surrogate’s interest-related determinants were strongly embraced in 8 EA models compared to 1 ME model. They were also strongly embraced in 5 P-viewpoint compared to 2 S-viewpoint models and strongly discounted in 4 P-viewpoint compared to 11 S-viewpoint models. Despite the overall predominance of patient’s health-related determinants and culture- and viewpoint-dependent differences, Q-methodology analysis identified relatively patient’s preference-influenced, religious/spiritual beliefs–influenced, emotion-influenced, and familism-influenced models and showed notable overlap in models. Conclusions Patient’s health was more important than other potential medical surrogate decision making determinants, including patient’s preference, for both ME and EA men and in all viewpoints. The relative importance of some determinants was culture- and viewpoint- dependent and allowed description of different albeit overlapping models.

show abstract

Section: Comparing Middle Eastern and East Asian Menmentioning

confidence: 88%

Importance Hierarchy of Surrogate Medical Decision Making Determinants: A Q-Methodology Study in Middle Eastern and East Asian Men

2020

View full text Add to dashboard Cite

show abstract

“…For example, ability to self-care was the most important and burden on family was the third most important end-of-life issues for patients, whereas amount of pain was the most important issue and burden on family was not an important issue for surrogates [41]. A study on advance care planning showed that men focused on minimally acceptable functional capacities while women took a broader view including meaningful times and places to die and psychological and economic burdens on families [42]. Another study showed that age, religiosity, and liberal-conservative social outlook explained 8, 5, and 5% of the variance in physicians attitude toward end-of-life decision-making [43].…”

Section: Discussionmentioning

confidence: 99%

Prediction of life-story narrative for end-of-life surrogate’s decision-making is inadequate: a Q-methodology study

et al. 2019

View full text Add to dashboard Cite

Background Substituted judgment assumes adequate knowledge of patient’s mind-set. However, surrogates’ prediction of individual healthcare decisions is often inadequate and may be based on shared background rather than patient-specific knowledge. It is not known whether surrogate’s prediction of patient’s integrative life-story narrative is better. Methods Respondents in 90 family pairs (30 husband-wife, 30 parent-child, 30 sibling-sibling) rank-ordered 47 end-of-life statements as life-story narrative measure (Q-sort) and completed instruments on decision-control preference and healthcare-outcomes acceptability as control measures, from respondent’s view (respondent-personal) and predicted pair’s view (respondent-surrogate). They also scored their confidence in surrogate’s decision-making (0 to 4 = maximum) and familiarity with pair’s healthcare-preferences (1 to 4 = maximum). Life-story narratives’ prediction was examined by calculating correlation of statements’ ranking scores between respondent-personal and respondent-surrogate Q-sorts (projection) and between respondent-surrogate and pair-personal Q-sorts before (simulation) and after controlling for correlation with respondent-personal scores (adjusted-simulation), and by comparing percentages of respondent-surrogate Q-sorts co-loading with pair-personal vs. respondent-personal Q-sorts. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was determined by percent concordance. Results were compared among subgroups defined by intra-pair relationship, surrogate’s decision-making confidence, and healthcare-preferences familiarity. Results Mean (SD) age was 35.4 (10.3) years, 69% were females, and 73 and 80% reported ≥ very good health and life-quality, respectively. Mean surrogate’s decision-making confidence score was 3.35 (0.58) and 75% were ≥ familiar with pair’s healthcare-preferences. Mean (95% confidence interval) projection, simulation, and adjusted-simulation correlations were 0.68 (0.67–0.69), 0.42 (0.40–0.44), and 0.26 (0.24–0.28), respectively. Out of 180 respondent-surrogate Q-sorts, 24, 9, and 32% co-loaded with respondent-personal, pair-personal, or both Q-sorts, respectively. Accuracy in predicting decision-control preference and healthcare-outcomes acceptability was 47 and 52%, respectively. Surrogate’s decision-making confidence score correlated with adjusted-simulation’s correlation score (rho = 0.18, p = 0.01). There were significant differences among the husband-wife, parent-child, and sibling-sibling subgroups in percentage of respondent-surrogate Q-sorts co-loading with pair-personal Q-sorts (38, 32, 55%, respectively, p = 0.03) and percent agreement on healthcare-outcomes acceptability (55, 35, and 67%, respectively, p = 0.002). Conclusions Despite high self-reported surrogate’s decision-making confidence and healthcare...

show abstract

“…End-of-life preferences may be culture and sex [21,22,43] as well as religiosity [23] dependent. We observed two notable differences between ME and EA respondents.…”

Section: Differences Between Me To Ea Respondentsmentioning

confidence: 99%

Factors underlying surrogate medical decision-making in middle eastern and east Asian women: a Q-methodology study

et al. 2020

View full text Add to dashboard Cite

Background: It is not clear how lay people prioritize the various, sometimes conflicting, interests when they make surrogate medical decisions, especially in non-Western cultures. The extent such decisions are perspective-related is also not well documented. Methods: We explored the relative importance of 28 surrogate decision-making factors to 120 Middle-Eastern (ME) and 120 East-Asian (EA) women from three perspectives, norm-perception (N), preference as patient (P), and preference as surrogate decision-maker (S). Each respondent force-ranked (one to nine) 28 opinion-items according to each perspective. Items' ranks were analyzed by averaging-analysis and Q-methodology. Results: Respondents' mean (SD) age was 33.2 (7.9) years; all ME were Muslims, 83% of EA were Christians. "Trying everything possible to save patient," "Improving patient health," "Patient pain and suffering," and/or "What is in the best interests of patient" were the three most-important items, whereas "Effect of caring for patient on all patients in society," "Effect of caring for patient on patients with same disease," and/or "Cost to society from caring for patient" were among the three least-important items, in each ME and EA perspectives. P-perspective assigned higher mean ranks to family and surrogate's needs and burdens-related items, and lower mean rank to "Fear of loss" than S-perspective (p<0.001). ME assigned higher mean ranks to "Medical facts" and "Surrogate own wishes for patient" and lower mean rank to "Family needs" in all perspectives (p<0.001). Q-methodology identified models that were relatively patient's preference-, patient's religious/spiritual beliefs-, or emotion-dependent (all perspectives); medical facts-dependent (N-and S-perspectives), financial needs-dependent (P-and S-perspectives), and family needs-dependent (P-perspective). Conclusions: 1) Patient's health was more important than patient's preference to ME and EA women; society interest was least important. 2) Family and surrogate's needs/ burdens were more important, whereas fear of loss was less important to respondents as patients than as surrogate decision-makers. 3) Family needs were more important to EA than ME respondents, the opposite was true for medical facts and surrogate's wishes for patient. 4) Q-methodology models that relatively emphasized various surrogate decision-making factors overlapped the ME and EA women' three perspectives.

show abstract

Substituted Judgment

Cited by 3 publications

References 3 publications

Importance Hierarchy of Surrogate Medical Decision Making Determinants: A Q-Methodology Study in Middle Eastern and East Asian Men

Importance Hierarchy of Surrogate Medical Decision Making Determinants: A Q-Methodology Study in Middle Eastern and East Asian Men

Prediction of life-story narrative for end-of-life surrogate’s decision-making is inadequate: a Q-methodology study

Factors underlying surrogate medical decision-making in middle eastern and east Asian women: a Q-methodology study

Contact Info

Product

Resources

About