Physicians' Views on the Importance of Patient Preferences in Surrogate Decision-Making

Authors

  • Alexia M. Torke MD, MS,

    1. From the Indiana University Center for Aging Research, Indianapolis, Indiana
    2. Regenstrief Institute, Inc., Indianapolis, Indiana
    3. Fairbanks Center for Medical Ethics, Indianapolis, Indiana
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  • Rachael Moloney BA,

    1. Department of Internal Medicine, University of Chicago Hospitals, Chicago, Illinois
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  • Mark Siegler MD,

    1. Department of Internal Medicine, University of Chicago Hospitals, Chicago, Illinois
    2. MacLean Center for Clinical Medical Ethics, Chicago, Illinois
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  • Anna Abalos MD,

    1. Department of Family Medicine, West Suburban Hospital, Oak Park, Illinois
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  • G. Caleb Alexander MD, MS

    1. Department of Internal Medicine, University of Chicago Hospitals, Chicago, Illinois
    2. MacLean Center for Clinical Medical Ethics, Chicago, Illinois
    3. Department of Family Medicine, West Suburban Hospital, Oak Park, Illinois
    4. Department of Pharmacy Practice, School of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
    5. Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois.
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  • This paper was presented in part at the American Geriatrics Society National Meeting, Washington, DC, April 30 to May 4, 2008, and the Society of General Internal Medicine Annual Meeting, Pittsburgh, Pennsylvania, April 9 to 12, 2008.

Address correspondence to Alexia M. Torke, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202. E-mail: atorke@iupui.edu

Abstract

OBJECTIVES: To explore the degree to which physicians report reliance on patient preferences when making medical decisions for hospitalized patients lacking decisional capacity.

DESIGN: Cross-sectional survey.

SETTING: One academic and two community hospitals in a single metropolitan area.

PARTICIPANTS: Two hundred eighty-one physicians who recently cared for hospitalized adults.

MEASUREMENTS: A self-administered survey addressing physicians' beliefs about ethical principles guiding surrogate decision-making and physicians' recent decision-making experiences.

RESULTS: Overall, 72.6% of physicians identified a standard related to patient preferences as the most important ethical standard for surrogate decision-making (61.2% identified advanced directives and 11.4% substituted judgment). Of the 73.3% of physicians who reported recently making a surrogate decision, 81.8% reported that patient preferences were highly important in decision-making, although only 29.4% reported that patient preference was the most important factor in the decision. Physicians were significantly more likely to base decisions on patient preferences when the patient was in the intensive care unit (odds ratio (OR)=2.92, 95% confidence interval (CI)=1.15–7.45) and less likely when the patient was older (OR=0.76 for each decade of age, 95% CI=0.58–0.99). The presence of a living will, prior discussions with the patient, and the physicians' beliefs about ethical guidelines did not significantly predict the physicians' reliance on patient preferences.

CONCLUSION: Although a majority of physicians identified patient preferences as the most important general ethical guideline for surrogate decision-making, they relied on a variety of factors when making treatment decisions for a patient lacking decisional capacity.

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