Surrogate Decision Making

Clinical Center

Investigators

Linked publications & trials

Abstract

Many patients are unable to make medical decisions for themselves (Raymont V, et al 2004; Silveira MJ, et al 2010). Current clinical practice relies on shared decision-making between clinicians and surrogates to make treatment decisions for these patients. This decision-making process is meant to promote medical care that accords with the patients own preferences and values. However, empirical data suggest that this approach faces two significant challenges. First, surrogates and clinicians have trouble predicting which treatment course patients would have chosen. Second, surrogates often experience significant emotional distress as a result of making treatment decisions. To address these concerns it has been suggested that the shared decision-making process might be supplemented with a Patient Preference Predictor (PPP). A PPP would provide a prediction of which treatment a given patient would want based on the treatment preferences of similar patients in similar circumstances. Preliminary research suggests that incorporating a PPP into the shared decision-making process might help to improve the extent to which medical decisions reflect the preferences of decisionally incapacitated patients and alleviate some of the emotional burden felt by surrogates and clinicians. A survey of patients found that, if the use of the PPP would increase the predictive accuracy of the shared decision-making process, a majority of patients believe that incorporating it into the shared decision-making process would be beneficial (Rid et al, 2014). Based on these findings, the present study is in the process of interviewing surrogates who have been involved in making decisions for an incapacitated patient to explore their perspectives on the PPP and how to incorporate it into medical decision-making.