Agreement between patients and their self-selected surrogates on difficult medical decisions

Background. -- Several studies have demonstrated that surrogate makers often are unable to use substituted judgment when asked to decisions for incompetent patients. This study further explored this, using a relatively young, healthy sample of 50 patient/surrogate. Methods. -- Patients were randomly recruited from a community family clinic and asked to select a surrogate. Five case vignettes were to patients and surrogates during separate interviews. Vignettes for decisions related to ventilation, resuscitation, and tube feeding a patient in permanent coma, amputation as life-extending treatment for a confused patient, and chemotherapy for a decisionally incapacitated with advanced cancer. Factors considered important to decision making also investigated. Results. -- As groups, patients and surrogates were as they chose to withdraw or continue treatment in the same. However, within individual pairs, agreement on treatment occurred 70% of the time even though surrogates were asked to base their treatment on substituted judgment. . . . Patients considered "burden on the" and "time left to live" as the most important factors in choosing difficult treatment options, while surrogates identified the patients' as the most important factor. Conclusions. -- The high rate of decisions underscores the importance of effective patient-surrogate before medical decision-making incompetence occurs. The of increasing patient-surrogate agreement on difficult medical by educational interventions should be explored.