What Counts as a Surrogate Decision?
Benjamin H Levi, Anne Ef Dimmock, Lauren J Van Scoy and 5 others
PMID 36997165WHAT IT FOUND
Family spokespersons and a research team disagreed in 18 cases about whether an event was a surrogate decision.
Disputes involved advocacy, discharge changes, medication requests, and simply relaying a patient's wishes.
Key findings
01In 109 final interviews, the team agreed a surrogate decision had been made in 50 cases (45.9%) and the patient had died without one in 41 cases (33.6%).
02In 18 cases (16.5%), spokespersons and the team disagreed about whether a surrogate decision had been made.
03Disputed cases included whether asking for a different discharge destination or relaying a patient's stated wishes counted as a surrogate decision.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The spokespersons had all engaged in advance care planning and their loved ones had advanced severe illnesses, so the findings may not apply to other families or settings. The classification depended on this particular research team's backgrounds, disciplinary biases, and decision-making preferences; another team might classify cases differently. Only 109 of 114 spokespersons reached final interviews, and 5 were returned to periodic phone follow-up. The authors say future studies are needed to apply this paradigm to surrogate decisions in other research and clinical contexts.
Declared interests
The authors declared no potential conflicts of interest. The work was supported by the National Institute of Nursing Research of the National Institutes of Health, under Award Number 2 R01 NR012757-08.
The easy way to misread this
Do not read the proposed variations as a tested communication intervention that improves surrogate decisions. The paper describes how a research team classified reported events and found disagreement, not that using the categories changes patient or family outcomes.