The Accuracy of Substituted Judgments in Patients with Terminal Diagnoses

Sulmasy, Daniel P.; Terry, Peter B.; Weisman, Carol S.; Miller, Deborah J.; Stallings, Rebecca; Vettese, Margaret; Haller, Karen B.

doi:10.7326/0003-4819-128-8-199804150-00002

Cited by 265 publications

(147 citation statements)

References 30 publications

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Section: Model-the Structural Equations Describing the Model Arementioning

confidence: 99%

“…5 Where items are structured to permit such responses, expressed preferences do vary continuously (Libbus and Russell 1995;PrincipeRodriguez et al 1999;Seckler et al 1991;Suhl et al 1994;Sulmasy et al 1998). where η 1 = surrogate preferences (latent); η 2 = spouse preferences (latent); Y PG = surrogate response for self, pain condition; Y CIG = surrogate response for self, cognitive impairment condition; Y P'S = surrogate report on spouse preference, pain condition; Y CI'S = surrogate report on spouse preference, cognitive impairment condition; Y PS = spouse response for self, pain condition; Y CIS = spouse response for self, cognitive impairment condition; the λ ij are coefficients to be estimated, and the ε i are random errors. In addition to the λ ij , the parameters of the model are the variances and covariances of the latent preferences (Ψ j ) and the variances and covariances of the errors in variables .…”

Section: Model-the Structural Equations Describing the Model Arementioning

confidence: 99%

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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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Section: Model-the Structural Equations Describing the Model Arementioning

confidence: 99%

Section: Model-the Structural Equations Describing the Model Arementioning

confidence: 99%

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

Moorman¹,

Hauser²,

Carr³

2009

ICPSR Data Holdings

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“…But the question rising is how often it is evaluated in the clinical practice, even though it is found to be high correlated with the NYHA classification. Additionally, patients with HF and their families come to difficult dilemmas or face options regarding continuing or not therapeutic interventions, especially when they have to consider about maintaining QoL against life prolongation or survival [22].Unfortunately, during the end of stage time, often patients' preferences are neglected or misperceived; supportive evidence from ESCAPE study has shown that there are patients who prefer to trade almost all survival in order to have better perceived health [23][24][25]. Therefore, health professionals caring for HF patients and especially those with progressed HF, need an understanding and knowledge of factors that may help them identify patients for whom extension of life is not the priority [26].…”

Section: Socio-economic Challengesmentioning

confidence: 99%

Heart failure: A challenging syndrome for health care professionals

Lambrinou¹,

Protopapas²,

Kalogirou³

2018

Cardiovasc Disord Med

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Research and evidence-based practice in heart failure (HF) have well been developed the latest years helping health professionals to cope with multiple care needs of patients with HF. The current review presents an overview of the challenging issues of health professionals who care for patients with HF. The review was based on the relevant databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library (reviews and clinical trials). Mortality and impaired quality of life in patients with HF still rises. This is mainly due to the ageing of population and the fact that prevalence of HF is higher in older people. Often HF in order people exists with co-morbidities which make HF diagnosis and management more difficult and complex.

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“…Clinicians may realize how family preferences influence decisions made for family members and argue, at least among themselves, that families are incapable of speaking objectively for their loved ones or representing their best interests. To date, studies (16,17) of substituted judgment among the families of terminally ill patients in the United States have shown that family decisions are reasonably concordant with what patients want, particularly if the two parties have discussed end-of-life issues beforehand. Physicians have been no better than family members in predicting patient choices in these investigations.…”

Section: Prognostic Factorsmentioning

confidence: 99%

The Pressure to Withhold or Withdraw Life-sustaining Therapy from Critically Ill Patients in the United States

Luce

White²

2007

Am J Respir Crit Care Med

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Physicians and nurses sometimes exert pressure on the families of critically ill patients to withhold or withdraw life-sustaining therapy from them. This pressure may stem from prognostic, professional, social, and economic factors. Although the pressure to limit life support may be appropriate in some circumstances, in others it is not justified. The pressure also may damage communications and cause resentment. If communications cannot be improved, and if the pressure cannot be relieved, a due process approach to conflict resolution that involves other parties may be required.

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The Accuracy of Substituted Judgments in Patients with Terminal Diagnoses

Cited by 265 publications

References 30 publications

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

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

Heart failure: A challenging syndrome for health care professionals

The Pressure to Withhold or Withdraw Life-sustaining Therapy from Critically Ill Patients in the United States

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