Accuracy of Primary Care and Hospital-Based Physicians' Predictions of Elderly Outpatients' Treatment Preferences With and Without Advance Directives

Coppola, Kristen M.; Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.

doi:10.1001/archinte.161.3.431

Cited by 191 publications

(105 citation statements)

References 32 publications

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“…A second line of research examines the concordance between a patient and his or her doctors, [14][15][16][17][18][19][20][21][22][23][24] or chosen surrogates. 17,18,21,[25][26][27][28][29][30][31][32] In such studies, individuals are asked what they would want for themselves in particular circumstances.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

“…They have generally been unsuccessful 32 or have improved predictions only modestly. 14,19 Finally, there has been extensive research examining whether patients really want their prior wishes to be the sole basis for decisions made on their behalf. This research reveals that the majority of patients prefer that family members or physicians have input into the decisions.…”

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

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Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

2008

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Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

Section: The Evidence Against Substituted Judgmentmentioning

confidence: 99%

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

2008

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“…Although surrogates generally have significantly more knowledge of patients' values and preferences than do clinicians (13), this knowledge is only part of what is required to fulfill the role of surrogate decision maker. Just as patients often need assistance in clarifying their values about difficult medical decisions (14), so too might surrogates need assistance to think through the patient's values and to apply them to complex medical decisions.…”

mentioning

confidence: 99%

The Facilitated Values History

Scheunemann

Arnold²,

White³

2012

Am J Respir Crit Care Med

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Many patients who develop incapacitating illness have not expressed clear treatment preferences. Therefore, surrogate decision makers are asked to make judgments about what treatment pathway is most consistent with the patient's values. Surrogates often struggle with such decisions. The difficulty arises because answering the seemingly straightforward question, "What do you think the patient would choose?" is emotionally, cognitively, and morally complex. There is little guidance for clinicians to assist families in constructing an authentic picture of the patient's values and applying them to medical decisions, in part because current models of medical decision making treat the surrogate as the expert on the patient's values and the physician as the expert on technical medical considerations. However, many surrogates need assistance in identifying and working through the sometimes conflicting values relevant to medical decisions near the end of life. We present a framework for clinicians to help surrogates overcome the emotional, cognitive, and moral barriers to high-quality surrogate decision making for incapacitated patients.

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“…If not, then should we go back to giving clinicians a more active role in making these decisions, even though they may be even less able to predict which option the patient would have chosen? 12 …”

Section: Practical Challengesmentioning

confidence: 99%

The Theory and Practice of Surrogate Decision‐Making

Wendler¹

2017

Hastings Center Report

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When a patient lacks decision‐making capacity and has not left a clear advance directive, there is now widespread agreement that patient‐designated and next‐of‐kin surrogates should implement substituted judgment within a process of shared decision‐making. Specifically, after discussing the “best scientific evidence available, as well as the patient's values, goals, and preferences” with the patient's clinicians, the patient‐designated or next‐of‐kin surrogate should attempt to determine what decision the patient would have made in the circumstances. To the extent that this approach works, it seems to provide about as much respect for the autonomy of incapacitated patients as we could ask for. But, as articles in this issue of the Report by Jeffrey Berger and by Ellen Robinson and colleagues emphasize, reality presents challenges.

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Accuracy of Primary Care and Hospital-Based Physicians' Predictions of Elderly Outpatients' Treatment Preferences With and Without Advance Directives

Cited by 191 publications

References 32 publications

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

Substituted Judgment: The Limitations of Autonomy in Surrogate Decision Making

The Facilitated Values History

The Theory and Practice of Surrogate Decision‐Making

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