Content area
Full Text
Rationale: Although there is a growing belief that physicians should routinely provide a recommendation to surrogates during deliberations about withdrawing life support, there is a paucity of empirical data on surrogates' perspectives on this topic.
Objectives: To understand the attitudes of surrogate decision-makers toward receiving a physician's recommendation during deliberations about whether to limit life support for an incapacitated patient.
Methods:We conducted a prospective, mixed methods study among 169 surrogate decision-makers for critically ill patients. Surrogates sequentially viewed two videos of simulated physician-surrogate discussions about whether to limit life support, which varied only by whether the physician gave a recommendation.
Measurements and Main Results: The main quantitative outcome was whether surrogates preferred to receive a physicians' recommendation. Surrogates also participated in an in-depth, semistructured interview to explore the reasons for their preference. Fifty-six percent (95/169) of surrogates preferred to receive a recommendation, 42% (70/169) preferred not to receive a recommendation, and 2% (4/169) felt that both approaches were equally acceptable. We identified four main themes that explained surrogates' preferences, including surrogates' perceptions of physicians' appropriate role in life or death decisions and their perceptions of the positive or negative consequences of a recommendation on the physician- surrogate relationship, on the decision-making process, and on long-term regret for the family.
Conclusions: There is no consensus among surrogates about whether physicians should routinely provide a recommendation regarding life support decisions for incapacitated patients. These findings suggest that physicians should ask surrogates whether they wish to receive a recommendation regarding life support decisions and should be flexible in their approach to decision-making.
Keywords: surrogate decision-making; physician recommendations; empirical ethics
Surrogate decision-making is a difficult task for family members of incapacitated patients (1-4). In intensive care units (ICUs), surrogate decision-making is the norm because critical illness and neuroactive medications often impair patients' cognition (5). Although roughly 500,000 Americans die yearly after decisions by surrogates to limit life support, there is a paucity of research about how to improve surrogate decision-making (6). There is, however, substantial evidence that the emotional needs of surrogate decision-makers are incompletely met (7), that communication between physicians and surrogates is inadequate (8-11), and that many surrogates feel ill-prepared to carry out their role (4, 12).
A particularly controversial aspect of surrogate decisionmaking is whether...