Beyond substituted judgment: How surrogates navigate end-of-life decision-making.
OBJECTIVE
To characterize how surrogates plan to make medical decisions for others.


METHODS
Descriptive study using semistructured qualitative interviews.


METHODS
Surrogates were interviewed by telephone from their homes.


METHODS
Fifty experienced surrogate decision-makers identified to make decisions for older, chronically ill veterans.


METHODS
Surrogates were asked to describe advance care planning conversations with loved ones and how they planned to make future medical decisions. Thematic content analysis was used to identify bases for decision-making.


RESULTS
Surrogates described the motivators and the content of advance care planning conversations with loved ones. Surrogates described five bases for decision-making: (1) conversations (making decisions based on their knowledge of their loved ones' preferences), (2) relying on documents (referring to their loved ones' advance care directives), (3) shared experience (believing an "inner sense" would guide decisions because of shared lived experience with loved ones), (4) surrogates' own values and preferences about life, and (5) surrogates' network (enlisting the help of others).


CONCLUSIONS
Although ethicists and clinicians expect surrogates to use substituted judgment or patients' best interests when making decisions, these data indicate that many surrogates rely on other factors such as their own best interests or mutual interests of themselves and the patient or intend to base substituted judgments on documents with which they have little familiarity.
Vig
Elizabeth K
EK
Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA. vigster@u.washington.edu
Taylor
Janelle S
JS
Starks
Helene
H
Hopley
Elizabeth K
EK
Fryer-Edwards
Kelly
K
D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods*; D020458:Third-Party Consent; D014481:United States; D014728:Veterans