When a terminal patient is unable to make personal decisions regarding its health, a close friend or family member is assigned to make the pertinent medical decisions involving the patient’s treatment.
A recent study has investigated the process family members make when being assigned as a surrogate decision maker for a terminal patient. Investigators were intrigued in how family members and close ones understood the prognosis of the patient.
Published in the Journal of the American Medical Association, the study sought to understand how this surrogates understood the patient’s prognosis, to make a correct decision.
Investigators from the University of Pittsburgh School of Medicine initiated a research based on surveys with doctors and surrogates located at intensive care units of the University of California at San Francisco Medical centers.
The data came from quantitative surveys and interviews at the center from January 2005 and July 2009.
Outcomes of the study
Dr. Douglas B. White is a professor at the Pitt School of Medicine Department of Critical Care Medicine and is the director of the investigation being held.
White along with his team studied a total of 229 decision-making surrogates between 35 and 56 years old, mostly women. Along with 99 physicians that were involved in the care and treatment of 174 terminal patients.
In the interviews, investigators asked both, surrogates and physicians, their opinion on the possible outcomes of determining ill patients on a scale from 0 to 100. Within the first findings, the study found a wide discrepancy between physicians and surrogates (122 cases of 299).
The discordance presented in the interviews were, the vast majority, related to misunderstandings of the prognosis of the patient and different beliefs on the disease of the ill subject (65 cases out of 299).
Investigators found that surrogates had a more optimistic view on the patient’s outcome than with the physician’s opinion.
“The concern is that patients would get a lot more intensive, invasive treatments than they would choose for themselves. This is the kind of end-of-life care that can be harmful to patients in terms of dignity and respect, it is also extremely costly for the health system,” said Dr. White in an interview with CBS news.
After the first interviews, the team of researchers invited the surrogates to guess the estimate result physicians gave to terminal patients, reassuring the finding that surrogates had more optimistic views.
Belief system
Researchers of the study also asked surrogates to discuss their outcomes into three belief systems that included: hope, strength and faith.
Investigators found that the most common belief system within the surrogates was hope “Family members believe that by holding a more optimistic belief about prognosis, that will actually help the patient have a better outcome” Said Dr. White in a press release
Other results of the belief system included the strength of the patient and the belief that the family member could outcome the disease or the situation. Faith and religion were also an important factor in the belief system.
Most surrogates hoped and prayed for a miracle that could save their family member.
Dr. White believes that this investigation would give a better understanding of the necessary needs for the surrogate- physician conversations and especially in the patient’s well-being.
Source: JAMA