Premium
Accuracy in Surrogate End‐of‐Life Medical Decision‐Making: A Critical Review
Author(s) -
Spalding Rachael
Publication year - 2021
Publication title -
applied psychology: health and well‐being
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.276
H-Index - 31
eISSN - 1758-0854
pISSN - 1758-0846
DOI - 10.1111/aphw.12221
Subject(s) - medical decision making , decision aids , process (computing) , psychology , decision making , quality of life (healthcare) , clinical decision making , medicine , management science , intensive care medicine , computer science , operations management , family medicine , nursing , alternative medicine , pathology , purchasing , economics , operating system
Background Increasing age is accompanied by a greater need for medical decisions, due in part to age‐related increases in chronic disease and disability. In later life, medical decisions about end‐of‐life care in particular are likely. However, a significant percentage of these decisions are made by surrogate decision‐makers. “Surrogates” are most often instructed to use the substituted judgment standard and make decisions that patients would choose if they were able. Whether surrogates make decisions that adequately match patients’ preferences is a concern. Surrogates are generally poor predictors of patient preferences (Shalowitz et al., 2006). However, no critical review of this literature has yet been published. Method A critical review was conducted to summarise and provide a methodological critique of 25 studies. Results These studies generally concur that patient–surrogate agreement on medical decisions is poor. However, this conclusion is qualified by inconsistencies in methodological quality and the potentially limited generalisability of these findings. Conclusions Clinical research incorporating standardised hypothetical decision‐making protocols, as well as triangulated data collection methods, would bolster confidence in future findings. Investigations prioritising the surrogate decision‐making process, rather than solely the decisional outcome, could better identify ways to improve the decision‐making process for incapacitated patients.