Social values as an independent factor affecting end of life medical decision making

Cohen, C. J.; Chen, Yifat; Orbach, Hedi; Freier‐Dror, Yossi; Auslander, Gail K.; Breuer, Gabriel S.

doi:10.1007/s11019-014-9581-x

Cited by 17 publications

(16 citation statements)

References 31 publications

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“…For instance, videos on invasive resuscitation efforts tended to bias patient decision towards comfort care [40,41]. And physicians' inclination for withholding or withdrawing treatments are known to be associated with their social values [42]. By implication, it is possible that decisions may be biased towards clinician's preference whether they may believe that limiting intensive management is better than prolonging suffering or whether clinicians opt for pursuing invasive life sustaining therapies [10,43,44].…”

Section: Discussionmentioning

confidence: 99%

A systematic review of effectiveness of decision aids to assist older patients at the end of life

Cardona

Benfatti-Olivato

Jansen

et al. 2017

Patient Education and Counseling

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Section: Discussionmentioning

confidence: 99%

A systematic review of effectiveness of decision aids to assist older patients at the end of life

Cardona

Benfatti-Olivato

Jansen

et al. 2017

Patient Education and Counseling

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“…At the center lies the discussion about choices made by medical doctors. The training of a physician consists of many complex and multi-dimensional components, but none may be more personal than the process of making ethically complex decisions which, research shows, can be influenced by physician’s personal characteristics, 1 , 2 personal social values, 3 and moral judgment. 4 , 5…”

Section: Introductionmentioning

confidence: 99%

The failure of medical education to develop moral reasoning in medical students

Murrell

2014

Int J Med Educ

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Objectives The goal of this study was to determine differences in moral judgment among students in medical school.Methods This cross-sectional study involved students currently enrolled in undergraduate medical education. Recruited via email, 192 students took an online version of the Defining Issues Test to determine their current stage of moral judgment, as well as their percentage of post conventional thought. Independent variables included year of graduation, which indicated curriculum completion as well as participation in a professionalism course. Data was analyzed primarily using One-Way Analysis of Variance.Results Of the 192 participants, 165 responses were utilized. ANOVA showed no significant differences in moral judgment between or among any of the student cohorts, which were grouped by year of matriculation. Comparisons included students in the four years of medical school, divided by graduation year; students about to graduate (n=30) vs. those still in school (n=135); and students who had participated in a course in professionalism (n=91) vs. those who had not (n=74). Conclusions These results demonstrate a lack of evolution in the moral reasoning of medical students and raise the issue of what might stimulate positive changes in moral judgment during the medical school experience.

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“…Each respondent performed Q-sorting according to each of the three perspectives (3 Q-sorts), in three random same-day Q-sorting sessions. The sessions included writing comments on the 6 extreme selections and were separated by respondents' completion of 1) respondents' characteristics sheet and 2) a previously published social value scale questionnaire [23].…”

Section: Data Collectionmentioning

confidence: 99%

“…End-of-life priorities [21,22] and factors underlying surrogate decision-making may be culture-dependent; religiosity and social outlook (on liberal-conservative continuum) contributed to the variance in physicians' attitude toward end-of-life decision-making, [23] and while 85% of the US public expressed desire to be informed if they had < 1 year to live, only 49% of Japanese did [17].…”

Section: Introductionmentioning

confidence: 99%

Factors underlying surrogate medical decision-making in middle eastern and east Asian women: a Q-methodology study

et al. 2020

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Background: It is not clear how lay people prioritize the various, sometimes conflicting, interests when they make surrogate medical decisions, especially in non-Western cultures. The extent such decisions are perspective-related is also not well documented. Methods: We explored the relative importance of 28 surrogate decision-making factors to 120 Middle-Eastern (ME) and 120 East-Asian (EA) women from three perspectives, norm-perception (N), preference as patient (P), and preference as surrogate decision-maker (S). Each respondent force-ranked (one to nine) 28 opinion-items according to each perspective. Items' ranks were analyzed by averaging-analysis and Q-methodology. Results: Respondents' mean (SD) age was 33.2 (7.9) years; all ME were Muslims, 83% of EA were Christians. "Trying everything possible to save patient," "Improving patient health," "Patient pain and suffering," and/or "What is in the best interests of patient" were the three most-important items, whereas "Effect of caring for patient on all patients in society," "Effect of caring for patient on patients with same disease," and/or "Cost to society from caring for patient" were among the three least-important items, in each ME and EA perspectives. P-perspective assigned higher mean ranks to family and surrogate's needs and burdens-related items, and lower mean rank to "Fear of loss" than S-perspective (p<0.001). ME assigned higher mean ranks to "Medical facts" and "Surrogate own wishes for patient" and lower mean rank to "Family needs" in all perspectives (p<0.001). Q-methodology identified models that were relatively patient's preference-, patient's religious/spiritual beliefs-, or emotion-dependent (all perspectives); medical facts-dependent (N-and S-perspectives), financial needs-dependent (P-and S-perspectives), and family needs-dependent (P-perspective). Conclusions: 1) Patient's health was more important than patient's preference to ME and EA women; society interest was least important. 2) Family and surrogate's needs/ burdens were more important, whereas fear of loss was less important to respondents as patients than as surrogate decision-makers. 3) Family needs were more important to EA than ME respondents, the opposite was true for medical facts and surrogate's wishes for patient. 4) Q-methodology models that relatively emphasized various surrogate decision-making factors overlapped the ME and EA women' three perspectives.

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Social values as an independent factor affecting end of life medical decision making

Cited by 17 publications

References 31 publications

A systematic review of effectiveness of decision aids to assist older patients at the end of life

A systematic review of effectiveness of decision aids to assist older patients at the end of life

The failure of medical education to develop moral reasoning in medical students

Factors underlying surrogate medical decision-making in middle eastern and east Asian women: a Q-methodology study

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