The Theory and Practice of Surrogate Decision‐Making

Wendler, David

doi:10.1002/hast.671

Cited by 21 publications

(14 citation statements)

References 13 publications

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“…Nevertheless, empirical data [ 28 ] show that there is still widespread scepticism among clinicians about the benefits of the presence of family members in ICUs. Although SDM is widely adopted in clinical practice [ 4 ], doubts still remain about the ability of relatives to become critical partners in decision-making. Two main core difficulties can be summarized: (1) understanding relevant medical information and appreciating consequences; (2) being morally responsible for the wishes of the patient.…”

Section: “Open” Icus: Still On the Waymentioning

confidence: 99%

New perspectives on substituted relational autonomy for shared decision-making in critical care

Grignoli

Bernardo

Malacrida³

2018

Crit Care

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In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients’ preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.

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Section: “Open” Icus: Still On the Waymentioning

confidence: 99%

New perspectives on substituted relational autonomy for shared decision-making in critical care

Grignoli

Bernardo

Malacrida³

2018

Crit Care

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“…The share decision making (SDM) is based on evidence-based medicine, combining the medical profession and the preferences of patients, discussing together and choosing the treatment options (Wendler, 2017). The interactive process and input of opinions from both sides are emphasized in order to reach the purpose of decision making (Chou, Liang, Sun, & Sun, 2017).…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Effectiveness of Share Decision Making and Standard Education for Cardiac Catheterization: A Pilot Study

Chiu

Cheng²,

Wang³

et al. 2021

IJSN

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Background: Cardiovascular diseases are the second leading cause of death in the top ten leading causes of death in 2018 in Taiwan, and coronary artery disease is one of the main causes.Aim: To compare whether there are differences in patient knowledge, anxiety, and satisfaction between the utilization of patient decision aid for cardiac catheterization and routine health education.Subject and methods: Between July 2020 and September 2020, subjects were recruited in the clinics of the Department of Cardiology in a Veterans hospital in northern Taiwan. An experimental design was used for the study. Subjects were divided into two different education tool groups by randomization table. Subjects filled out the questionnaires before and after the education.Result: The patient knowledge before and after education in the RC group was improved by 2.30 points, and SDM group increased by 1.50 points (p-value<0.05). The score of anxiety decreased by 0.41 points in the RC group after the education, and the score of anxiety decreased by 0.33 points in the SDM group. The levels of satisfaction of the SDM group were all higher than the RC group, but the satisfaction score for the duration of education in both groups was relatively low.Conclusion: Regardless of the standard or SDM education model, the knowledge level of patients can be improved, and there was a statistically significant difference (P<0.05). The anxiety of patients in both groups was reduced. The satisfactions of education in the SDM group were better than those of the RC group. The duration of education was the item with low satisfaction for both groups.Recommendations: Both methods of education can help patients increase their knowledge. The establishment of manpower responsible for education. Allowing patients to receive education before the examination can decrease anxiety and has clinical benefits.

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Section: Introductionmentioning

confidence: 99%

“…First, some patients will not have made their wishes for health care known in advance of loss of capacity [7][8][9][10]. Others may have discussed their wishes with their loved ones, and some may have put them in writing, but without being specific about how they want to be treated if they were to develop a life-threatening infection [10]. Second, the extent to which antibiotic therapy significantly improves comfort or prolongs life in these patients is still being debated in the scientific literature [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders

et al. 2021

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Background Healthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity. Methods We conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death. Results Support for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics. Conclusions Findings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered.

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The Theory and Practice of Surrogate Decision‐Making

Cited by 21 publications

References 13 publications

New perspectives on substituted relational autonomy for shared decision-making in critical care

New perspectives on substituted relational autonomy for shared decision-making in critical care

A Comparison of the Effectiveness of Share Decision Making and Standard Education for Cardiac Catheterization: A Pilot Study

Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders

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