title: Attunement and alignment of people with schizophrenia and their preferred alternative decision-makers: An exploratory pilot study comparing treatment and research decisions.
abstract: BACKGROUND
  Schizophrenia is a serious mental disorder that may affect the decisional capacity, and as a consequence, preferred alternative decision-makers may be engaged to help with clinical care and research-related choices. Ideally, alternative decision-makers will seek to make decisions that fit with the views and preferences of the ill individual. Few data exist, however, comparing the views of alternative decision-makers to those of individuals with schizophrenia.
  
  
  METHODS
  We conducted a written survey with individuals with schizophrenia living in a community setting, and a parallel survey with the person whom the ill individual identified as being a preferred alternative decision-maker. Complete data were obtained on 20 pairs (n = 40, total). Domains queried included (a) burden, happiness, and safety of the ill individual and of his or her family in treatment and research decisions and (b) importance of ethical principles in every day life. Two-sided paired t-tests and graphical summaries were used to compare responses.
  
  
  RESULTS
  Individuals with schizophrenia and their linked preferred alternative decision-makers were attuned on four of six aspects of treatment decision-making and on all six aspects of research decision-making that we queried.
  
  
  CONCLUSIONS
  The preferred alternative decision-makers overall demonstrated attunement to the views of the ill individuals in this small study. Ill individuals and their preferred alternative decision-makers were aligned in their views of ethically-salient aspects of every day life. These novel findings suggest that alternative decision-makers identified by ill individuals may be able to guide choices based on an accurate understanding of the ill individuals' views and values.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA. Electronic address: robertsl@stanford.edu.
authors.forename: Laura Weiss
authors.initials: LW
authors.lastname: Roberts
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
authors.forename: Jane Paik
authors.initials: JP
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D010865:Pilot Projects; D019727:Proxy / Q000523:psychology*; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D018454:Spouses / Q000523:psychology; D055815:Young Adult
keywords: Ethics; Preferred alternative decision-makers; Schizophrenia; Vulnerability