Surrogate inaccuracy in predicting older adults’ desire for life-sustaining interventions in the event of decisional incapacity: is it due in part to erroneous quality-of-life assessments?

Abstract

ISRCTN89993391.

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

“…undertreat (e.g., Bravo et al, 2017). The current findings are more consistent with literature regarding discrepancies in estimating levels of pain or discomfort experienced by others.…”

“…This finding adds to the body of evidence suggesting that individuals who make decisions for patients in end-of-life situations may not be trusted to consistently select the treatment that the patient would have wanted (Torke, 2008). The level of agreement found in the current study is notably lower than that reported in a systematic review of the literature by Shalowitz et al (2006; 68% agreement, on average), yet it is consistent with levels reported by more recent investigations of surrogate decision-making accuracy (e.g., Bravo et al, 2017).…”

“…The current findings are more consistent with literature regarding discrepancies in estimating levels of pain or discomfort experienced by others. In particular, the surrogate decision-making literature reflects that surrogates are only moderately successful when gauging levels of pain experienced by the patients they serve (Desbiens & Mueller-Rizner, 2000) and that surrogates tend to underestimate patients' perceptions of an acceptable quality of life (Bravo et al, 2017).…”

Perhaps quality of life should not be used as a trigger for discussing resuscitation and advance care plans

“…11 Differences in QOL ratings were associated with surrogates' inaccuracy of predicting older adults' treatment preferences in hypothetical situations. 12 For individuals with dementia, discrepancy was observed between selfrated and carer-rated perceptions of QOL. 13,14 A review of dementia specific-measurement scales found a lack of consensus on measures of QOL.…”

“…Substitute decision‐making by healthcare proxies provides a view to help direct medical management, but an opinion of QOL by a surrogate does not necessarily concur with the QOL ratings of the person they represent . Differences in QOL ratings were associated with surrogates’ inaccuracy of predicting older adults’ treatment preferences in hypothetical situations …”