title: Communicating with clinicians: the experiences of surrogate decision-makers for hospitalized older adults.
abstract: OBJECTIVE
  To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult.
  
  
  METHODS
  Semistructured interviews about a recent hospitalization.
  
  
  METHODS
  Two hospitals affiliated with one large medical school: an urban public hospital and a university-affiliated tertiary referral hospital.
  
  
  METHODS
  Surrogates were eligible if they had recently made a major medical decision for a hospitalized individual aged 65 and older and were available for an interview within 1 month (2-5 months if the patient died).
  
  
  METHODS
  Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory.
  
  
  RESULTS
  Thirty-five surrogates were interviewed (80% female, 44% white, 56% African American). Three primary themes emerged. First, it was found that the nature of surrogate-clinician relationships was best characterized as a relationship with a "team" of clinicians rather than individual clinicians because of frequent staff changes and multiple clinicians. Second, surrogates reported their communication needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described trust and mistrust, which were formed largely through surrogates' communication experiences.
  
  
  CONCLUSIONS
  In the hospital, surrogates form relationships with a "team" of clinicians rather than with individuals, yet effective communication and expressions of emotional support frequently occur, which surrogates value highly. Future interventions should focus on meeting surrogates' needs for frequent communication and high levels of information and emotional support.
authors.affiliation: Center for Aging Research, Regenstrief Institute, Inc., Indiana University, Indianapolis, Indiana 46202, USA. atorke@iupui.edu
authors.forename: Alexia M
authors.initials: AM
authors.lastname: Torke
authors.forename: Sandra
authors.initials: S
authors.lastname: Petronio
authors.forename: Christianna E
authors.initials: CE
authors.lastname: Purnell
authors.forename: Greg A
authors.initials: GA
authors.lastname: Sachs
authors.forename: Paul R
authors.initials: PR
authors.lastname: Helft
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000368:Aged; D003142:Communication; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D020458:Third-Party Consent