title: End-of-life decision-making confidence in surrogates of African-American dialysis patients is overly optimistic.
abstract: BACKGROUND
  Recent studies suggest that surrogate decision makers may be too optimistic about their end-of-life decision making abilities for loved ones. We examined surrogates' decision making confidence with an emphasis on its linkages to their understandings of patients' values and goals for end-of-life care.
  
  
  METHODS
  We used baseline data from a randomized trial with 58 dyads of African-American dialysis patients and their surrogates who separately completed the Values of Life-Sustaining Treatment Outcomes and the Goals of Care documents. Surrogates also completed a Surrogate Decision Making Confidence Scale.
  
  
  RESULTS
  Overall, 60% of surrogates were unsure how their loved ones would feel about continuing life-sustaining treatment, including dialysis, in at least one of the four outcomes presented in the Values of Life-Sustaining Treatment Outcomes. For goals of care near end of life, 67.2% to 69.0% of patients preferred comfort care only, but only 20 (34.5%) surrogates were congruent with patients on Goals of Care. Nonetheless, surrogates' confidence was high (M=3.23 out of 4.0). Surrogates' confidence was positively associated with dyad congruence in values for life-sustaining treatment at only a small magnitude (Spearman's rho=.31, p=.02), but not with dyad congruence in goals of care (χ(2)=2.13, df=1, p=.19).
  
  
  CONCLUSIONS
  Surrogates' confidence had little association with their actual understanding of patients' values and goals. Interventions to prepare patients and surrogates for end-of-life decision making may need to address overconfidence and help surrogates recognize their limited understanding of patients' values and goals.
authors.affiliation: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. songm@email.unc.edu
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Ward
authors.forename: Feng-Chang
authors.initials: FC
authors.lastname: Lin
mesh_terms: D016223:Advance Directives; D001741:Black or African American; D016009:Chi-Square Distribution; D003142:Communication; D016001:Confidence Intervals; D003657:Decision Making; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017060:Patient Satisfaction; D011594:Psychometrics; D006435:Renal Dialysis / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States