Communicating with Clinicians: The Experiences of Surrogate Decision-Makers for Hospitalized Older Adults

Authors

  • Alexia M. Torke MD, MS,

    Corresponding author
    1. Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, Indiana
    2. Charles Warren Fairbanks Center for Medical Ethics, IU Health, Indianapolis, Indiana
    • Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana
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  • Sandra Petronio PhD,

    1. Charles Warren Fairbanks Center for Medical Ethics, IU Health, Indianapolis, Indiana
    2. Department of Communication Studies, Indiana University – Purdue University Indianapolis, Indianapolis, Indiana
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  • Christianna E. Purnell BA,

    1. Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana
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  • Greg A. Sachs MD,

    1. Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana
    2. Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, Indiana
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  • Paul R. Helft MD,

    1. Charles Warren Fairbanks Center for Medical Ethics, IU Health, Indianapolis, Indiana
    2. Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana
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  • Christopher M. Callahan MD

    1. Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana
    2. Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, Indiana
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Address correspondence to Alexia Torke, IU Center for Aging Research, 410 W. 10th St., Indianapolis, IN 46202. E-mail: atorke@iupui.edu

Abstract

Objectives

To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult.

Design

Semistructured interviews about a recent hospitalization.

Setting

Two hospitals affiliated with one large medical school: an urban public hospital and a university-affiliated tertiary referral hospital.

Participants

Surrogates were eligible if they had recently made a major medical decision for a hospitalized individual aged 65 and older and were available for an interview within 1 month (2–5 months if the patient died).

Measurements

Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory.

Results

Thirty-five surrogates were interviewed (80% female, 44% white, 56% African American). Three primary themes emerged. First, it was found that the nature of surrogate–clinician relationships was best characterized as a relationship with a “team” of clinicians rather than individual clinicians because of frequent staff changes and multiple clinicians. Second, surrogates reported their communication needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described trust and mistrust, which were formed largely through surrogates' communication experiences.

Conclusion

In the hospital, surrogates form relationships with a “team” of clinicians rather than with individuals, yet effective communication and expressions of emotional support frequently occur, which surrogates value highly. Future interventions should focus on meeting surrogates' needs for frequent communication and high levels of information and emotional support.

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