Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic.
Rachael L Spalding, Barry Edelstein
PMID 34144854WHAT IT FOUND
Surrogates predicted hypothetical end-of-life treatment choices poorly. 53.9% of pairs disagreed on at least one scenario, and 61.2% of inaccurate pairs chose less treatment than the patient wanted.
Key findings
01Surrogates were inaccurate in the hypothetical end-of-life decisions: 53.9% of pairs disagreed on at least one scenario.
02When pairs disagreed, 61.2% of inaccurate pairs involved the surrogate choosing less treatment than the patient wanted.
03Surrogates with greater anxiety about COVID-19 selected more intensive treatments in the vignettes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Hypothetical vignettes may not match real decisions made at the bedside for an ill patient. The people labelled as patients were healthy community adults assigned a role, not patients with illness, frailty, or a real end-of-life choice. The sample was mostly White, mostly spouses or romantic partners, and younger than typical real-world surrogates, so it may not represent families in intensive care units. COVID-19 anxiety was measured with a single item because no validated measure existed when the study was designed. The regression models were exploratory, and modest coefficients mean important predictors may have been missed. Seven pairs were excluded from the recruited sample for incomplete responses or attention-check failures.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read these results as evidence that real surrogates will choose wrongly at the bedside. The pairs were healthy adults answering hypothetical vignettes, and the study did not test any communication or decision-support intervention.