Physician understanding and application of surrogate decision-making laws in clinical practice

Comer, Amber; Gaffney, Margaret M.; Stone, Cynthia; Torke, Alexia M.

doi:10.1080/23294515.2016.1234520

Cited by 8 publications

(12 citation statements)

References 11 publications

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“…Establishing a Guardianship is both costly and time consuming (24–25). Lastly, laws which limit surrogates to only traditional persons place physicians in the position where they have to choose between allowing the non-traditional surrogate to make medical decisions even though it is against the law, or the physician must send the surrogate to court to obtain a Guardianship (26).…”

Section: Discussionmentioning

confidence: 99%

Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

et al. 2018

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This study shows that both traditional and nontraditional surrogates, who are a patient's primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of surrogates authorized by state statute to include more nontraditional surrogates may be necessary.

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Section: Discussionmentioning

confidence: 99%

Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

et al. 2018

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“…Physicians were asked to complete a pretest which consisted of seven questions about the new law prior to watching the video. The questions were part of a validated survey regarding physician knowledge of the health care law that had been used in a previous study (13). The questions posed hypothetical vignettes which asked physicians to identify the legal surrogate medical decision maker from a list of options.…”

Section: Methodsmentioning

confidence: 99%

“…One area of clinical practice which requires the implementation of a law in every day clinical practice is the identification of the appropriate surrogate decision maker for an incapacitated patient. In order to obtain information about the patient's health history, goals, values, and preferences and to make decisions about medical treatments, physicians must be able to identify the correct surrogate, often in urgent or emergent situations (10)(11)(12)(13). A change in a state public health law for identifying surrogate decision makers provided the opportunity to conduct a study examining whether an educational video about a new state level health care law would improve both physicians' knowledge of the law and how to implement the law during clinical practice.…”

Section: Introductionmentioning

confidence: 99%

An Educational Video Improves Physician Knowledge of a Health Care Law that Affects Patient Care during Hospital Clinical Practice

Comer

Slaven

Torke

2021

Journal of Public Health Research

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When public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians’ knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care

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“…Nevertheless, nearly 10% of patients select nonrelatives as their healthcare agents (56). Clinicians are often unfamiliar with these laws, which vary considerably from state to state (3,(57)(58)(59). Institutions should manage decisionmaking for unrepresented patients using collaboration between the clinical team and a diverse interprofessional, multidisciplinary committee rather than ad hoc by treating clinicians.…”

Section: Recommendationmentioning

confidence: 99%

Making Medical Treatment Decisions for Unrepresented Patients in the ICU. An Official American Thoracic Society/American Geriatrics Society Policy Statement

Pope¹,

Bennett²,

Carson³

et al. 2020

Am J Respir Crit Care Med

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Background and Rationale: ICU clinicians regularly care for patients who lack capacity, an applicable advance directive, and an available surrogate decision-maker. Although there is no consensus on terminology, we refer to these patients as "unrepresented." There is considerable controversy about how to make treatment decisions for these patients, and there is significant variability in both law and clinical practice. Purpose and Objectives: This multisociety statement provides clinicians and hospital administrators with recommendations for decision-making on behalf of unrepresented patients in the critical care setting. Methods: An interprofessional, multidisciplinary expert committee developed this policy statement by using an iterative consensus process with a diverse working group representing critical care medicine, palliative care, pediatric medicine, nursing, social work, gerontology, geriatrics, patient advocacy, bioethics, philosophy, elder law, and health law. Main Results: The committee designed its policy recommendations to promote five ethical goals: 1) to protect highly vulnerable patients, 2) to demonstrate respect for persons, 3) to provide appropriate medical care, 4) to safeguard against unacceptable discrimination, and 5) to avoid undue influence of competing obligations and conflicting interests. These recommendations also are intended to strike an appropriate balance between excessive and insufficient procedural safeguards. The committee makes the following recommendations: 1) institutions should offer advance care planning to prevent patients at high risk for becoming unrepresented from meeting this definition; 2) institutions should implement strategies to determine whether seemingly unrepresented patients are actually unrepresented, including careful capacity assessments and diligent searches for potential surrogates; 3) institutions should manage decision-making for unrepresented patients using input from a diverse interprofessional, multidisciplinary committee rather than ad hoc by treating clinicians; 4) institutions should use all available information on the patient's preferences and values to guide treatment decisions; 5) institutions should manage decision-making for unrepresented patients using a fair process that comports with procedural due process; 6) institutions should employ this fair process even when state law authorizes procedures with less oversight. Conclusions: This multisociety statement provides guidance for clinicians and hospital administrators on medical decision-making for unrepresented patients in the critical care setting.

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Physician understanding and application of surrogate decision-making laws in clinical practice

Abstract: Background: Although state surrogate laws are the most common way surrogate decision makers are

Cited by 8 publications

References 11 publications

Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

An Educational Video Improves Physician Knowledge of a Health Care Law that Affects Patient Care during Hospital Clinical Practice

Making Medical Treatment Decisions for Unrepresented Patients in the ICU. An Official American Thoracic Society/American Geriatrics Society Policy Statement

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