Discrepancies in end-of-life decisions between elderly patients and their named surrogates.
BACKGROUND
This study aims to determine the attitudes of Asian elderly patients towards invasive life support measures, the degree of patient-surrogate concordance in end-of-life decision making, the extent to which patients desire autonomy over end-of-life medical decisions, the reasons behind patients' and surrogates' decisions, and the main factors influencing patients' and surrogates' decision-making processes. We hypothesize that there is significant patient-surrogate discordance in end-of-life decision making in our community.


METHODS
The patient and surrogate were presented with a hypothetical scenario in which the patient experienced gradual functional decline in the community before being admitted for life-threatening pneumonia. It was explained that the outcome was likely to be poor even with intensive care and each patient-surrogate pair was subsequently interviewed separately on their opinions of extraordinary life support using a standardised questionnaire. Both parties were blinded to each other's replies.


RESULTS
In total, 30 patients and their surrogate decision-makers were interviewed. Twenty-eight (93.3%) patients and 20 (66.7%) surrogates rejected intensive care. Patient-surrogate concurrence was found in 20 pairs (66.7%). Twenty-four (80.0%) patients desired autonomy over their decision. The patients' and surrogates' top reasons for rejecting intensive treatment were treatment-related discomfort, poor prognosis and financial cost. Surrogates' top reasons for selecting intensive treatment were the hope of recovery, the need to complete final tasks and the sanctity of life.


CONCLUSIONS
The majority of patients desire autonomy over critical care issues. Relying on the surrogates' decisions to initiate treatment may result in treatment against patients' wishes in up to one-third of critically ill elderly patients.
National University of Singapore, Yong Loo Lin School of Medicine. aaronfoosongchuan@gmail.com
Aaron S C
AS
Foo
Tze Wee
TW
Lee
Chai Rick
CR
Soh
D024362:Advance Directive Adherence; D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D003422:Critical Care / Q000523:psychology*; D016638:Critical Illness / Q000523:psychology* / Q000628:therapy; D003657:Decision Making; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D008297:Male; D026684:Personal Autonomy