Physicians' experience with surrogate decision making for hospitalized adults

Alexia M. Torke, Mark Siegler, Anna Abalos, Rachael M. Moloney, G. Caleb Alexander

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Hospitalized patients frequently lack decision-making ability, yet little is known about physicians' approaches to surrogate decision making. Objective: To describe physicians' experiences with surrogate communication and decision making for hospitalized adults. Design: Cross-sectional written survey. Participants: Two hundred eighty-one physicians who recently cared for adult inpatients in one academic and two community hospitals. Measurements: Key features of physicians' most recent surrogate decision-making experience, including the nature of the decision, the physician's reaction, physician-surrogate communication and physician-surrogate agreement about the best course of action. Results: Nearly three fourths of physicians (73%, n = 206) had made a major decision with a surrogate during the past month. Although nearly all patients (90%) had a surrogate, physicians reported trouble contacting the surrogate in 21% of cases. Conflict was rare (5%), and a majority of physicians agreed with surrogates about the medical facts (77%), prognosis (72%) and best course of action (65%). After adjustment for patient, physician and decision characteristics, agreement about the best course of action was more common among surrogates for older patients [prevalence ratio (PR) = 1.17 for each decade; 95% confidence interval (CI) 1.02-1.31], ICU patients (PR = 1.40; CI 1.14-1.51) and patients who had previously discussed their wishes (PR = 1.60; CI 1.30-1.76), and less common when surrogates were difficult to contact (PR = 0.59; CI 0.29-0.92) or when the physician self-identified as Asian (PR = 0.60; CI 0.30-0.94). Conclusion: Surrogate decision making is common among hospitalized adults. Physician-surrogate decision making may be enhanced if patients discuss their preferences in advance and if physician contact with surrogate decision makers is facilitated.

Original languageEnglish (US)
Pages (from-to)1023-1028
Number of pages6
JournalJournal of general internal medicine
Volume24
Issue number9
DOIs
StatePublished - Sep 1 2009

Fingerprint

Decision Making
Physicians
Confidence Intervals
Communication
Aptitude
Community Hospital
Inpatients
Cross-Sectional Studies

Keywords

  • Communication
  • Decision making
  • Ethics
  • Proxy

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Physicians' experience with surrogate decision making for hospitalized adults. / Torke, Alexia M.; Siegler, Mark; Abalos, Anna; Moloney, Rachael M.; Alexander, G. Caleb.

In: Journal of general internal medicine, Vol. 24, No. 9, 01.09.2009, p. 1023-1028.

Research output: Contribution to journalArticle

Torke, Alexia M. ; Siegler, Mark ; Abalos, Anna ; Moloney, Rachael M. ; Alexander, G. Caleb. / Physicians' experience with surrogate decision making for hospitalized adults. In: Journal of general internal medicine. 2009 ; Vol. 24, No. 9. pp. 1023-1028.
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abstract = "Background: Hospitalized patients frequently lack decision-making ability, yet little is known about physicians' approaches to surrogate decision making. Objective: To describe physicians' experiences with surrogate communication and decision making for hospitalized adults. Design: Cross-sectional written survey. Participants: Two hundred eighty-one physicians who recently cared for adult inpatients in one academic and two community hospitals. Measurements: Key features of physicians' most recent surrogate decision-making experience, including the nature of the decision, the physician's reaction, physician-surrogate communication and physician-surrogate agreement about the best course of action. Results: Nearly three fourths of physicians (73{\%}, n = 206) had made a major decision with a surrogate during the past month. Although nearly all patients (90{\%}) had a surrogate, physicians reported trouble contacting the surrogate in 21{\%} of cases. Conflict was rare (5{\%}), and a majority of physicians agreed with surrogates about the medical facts (77{\%}), prognosis (72{\%}) and best course of action (65{\%}). After adjustment for patient, physician and decision characteristics, agreement about the best course of action was more common among surrogates for older patients [prevalence ratio (PR) = 1.17 for each decade; 95{\%} confidence interval (CI) 1.02-1.31], ICU patients (PR = 1.40; CI 1.14-1.51) and patients who had previously discussed their wishes (PR = 1.60; CI 1.30-1.76), and less common when surrogates were difficult to contact (PR = 0.59; CI 0.29-0.92) or when the physician self-identified as Asian (PR = 0.60; CI 0.30-0.94). Conclusion: Surrogate decision making is common among hospitalized adults. Physician-surrogate decision making may be enhanced if patients discuss their preferences in advance and if physician contact with surrogate decision makers is facilitated.",
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