Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic

Abstract

Objective Surrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates’ characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates’ accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient. Methods 154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer. Results When taken all together in a predictive model, the variables significantly predicted surrogatesʼ accuracy, F (6) = 3.03, R 2 = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R 2 = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions. Conclusions Consistent with prior research, this study found that surrogates’ characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions. Practice implications These findings can inform development of decision-making interventions to improve surrogates’ accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.

RESPONDER: A qualitative study of ethical issues faced by critical care nurses during the COVID‐19 pandemic

“…Though it has been previously established that surrogate decision‐makers often incorrectly predict patient's wishes in various clinical scenarios (Shalowitz et al, 2006 ), there is limited research that captured nurses' perceptions of this issue during the pandemic. Spalding and Edelstein ( 2022 ) found that during the pandemic, uncertainty regarding illness trajectory exacerbated uncertainty about patient wishes amongst surrogate decision‐makers. Since nurses in this study described perceptions that patient wishes were unknown or that surrogates decisions did not reflect patient wishes, it may be important to understand that visitation restrictions and surrogates' motivation to see loved ones are powerful motivators of decision making that may reappear in another pandemic.…”

“…there is limited research that captured nurses' perceptions of this issue during the pandemic. Spalding and Edelstein (2022) Despite significant barriers to providing quality care, nurses described situations in which they perceived that their personal strengths and values enabled them to provide good care and they verbalized a commitment to treating patients as family members. Goethals et al (2010) described how some expert nurses were able to break away from conformist decision-making and behaviours, combining critical thinking and identification of patient needs to identify a pathway forward.…”

“We have to save him”: a qualitative study on care transition decisions in Ontario’s long-term care settings during the COVID-19 pandemic

“…Participants prioritized the perceived needs and preferences of the residents to the best of their abilities when making their decisions. Unfortunately, emerging literature on surrogate decision-making during the COVID-19 pandemic has shown that surrogates often have poor accuracy in predicting patient preferences [ 50 ]. These discrepancies appear relevant in this study, as some care partners described moving the residents despite their expressed preferences to stay in LTC.…”

Automatic Decision-Making Style Recognition Method Using Kinect Technology

“…Individual decision-making styles tend to be habitual, and people with different decisionmaking styles react differently in specific decision contexts based on established habits (Scott and Bruce, 1995). Decision-making style is an important factor affecting behavior in many fields, such as career development (Mau, 1995;Tinsley et al, 2002;Paivandy et al, 2008), team effectiveness (Verma et al, 2016), school choice (Ueichi et al, 2012), consumption (Zhu et al, 2012), traffic safety (Ju et al, 2019), medical care (Spalding and Edelstein, 2021), and gambling (Cosenza et al, 2019). At the same time, decision-making style is closely related to personality traits (Byrne et al, 2015;Wise et al, 2015;Iennaco et al, 2018;Farcic et al, 2020).…”