title: "Speaking-for" and "speaking-as": pseudo-surrogacy in physician-patient-companion medical encounters about advanced cancer.
abstract: OBJECTIVE
  To examine using audio-recorded encounters the extent and process of companion participation when discussing treatment choices and prognosis in the context of a life-limiting cancer diagnosis.
  
  
  METHODS
  Qualitative analysis of transcribed outpatient visits between 17 oncologists, 49 patients with advanced cancer, and 34 companions.
  
  
  RESULTS
  46 qualifying companion statements were collected from a total of 28 conversations about treatment choices or prognosis. We identified a range of companion positions, from "pseudo-surrogacy" (companion speaking as if the patient were not able to speak for himself), "hearsay", "conflation of thoughts", "co-experiencing", "observation as an outsider", and "facilitation". Statements made by companions were infrequently directly validated by the patient.
  
  
  CONCLUSIONS
  Companions often spoke on behalf of patients during discussions of prognosis and treatment choices, even when the patient was present and capable of speaking on his or her own behalf.
  
  
  CONCLUSIONS
  The conversational role of companions as well as whether the physician checks with the patient can determine whether a companion facilitates or inhibits patient autonomy and involvement. Physicians can reduce ambiguity and encourage patient participation by being aware of when and how companions may speak on behalf of patients and by corroborating the companion's statement with the patient.
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA. Electronic address: Benjamin_Mazer@urmc.rochester.edu.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Mazer
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Cameron
authors.affiliation: School of Nursing, Clemson University, Clemson, SC, USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: DeLuca
authors.affiliation: Department of Medicine, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.affiliation: Departments of Family Medicine, Psychiatry, Oncology, and Nursing, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Epstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D003142:Communication; D005260:Female; D033062:Friends; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D009819:Office Visits; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians; D011320:Primary Health Care / Q000458:organization & administration; D011368:Professional-Family Relations; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration; D013637:Tape Recording; D055815:Young Adult
keywords: Communication; Companion; Ethics; Family; Patient–physician communication; Qualitative research; Surrogacy