title: Are individuals living with mental illness and their preferred alternative decision-makers attuned and aligned in their attitudes regarding treatment decisions?
abstract: Mental disorders account for considerable suffering and societal burden. Prospective alternative decision-makers may be engaged in helping make treatment decisions for those who live with serious mental disorders. Little is known about the ways in which alternative decision makers arrive at treatment recommendations and whether the perspectives of alternative decision makers and ill individuals are aligned.
  
  
  
  The authors queried community-dwelling individuals diagnosed with schizophrenia, anxiety, or mood disorders and their preferred alternative decision-makers on issues regarding treatment decisions and underlying ethically-salient perspectives using a written survey instrument. Complete data were obtained on 26 pairs (n = 52, total). Outcomes included perspectives on clinical decision-making and underlying values that may shape their life choices. Two-sided paired t-tests and graphical representations were used.
  
  
  
  We found that preferred alternative decision-makers overall accurately predicted the views of ill individuals with respect to the role of the individual and of family in treatment decision making. Preferred alternative decision-makers slightly overestimated autonomy-related perspectives. The personal views of ill individuals and preferred alternative decision-makers were aligned with respect to different physical and mental disorders, except in relation to alcohol and substance use where alternative decision-makers placed greater emphasis on autonomy. Alignment was also discovered on underlying life values, except the role of spirituality which was greater among alternative decision-makers.
  
  
  
  Preferred alternative decision-makers are an ethical safeguard to ensure the wellbeing and rights of seriously ill individuals. In this pilot study, preferred alternative decision makers were aligned with their ill family members concerning treatment-related decisions and underlying life values. Future research should continue to explore and clarify the views of ill individuals and alternative decision makers to determine the quality of this safeguard used in clinical settings.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States. Electronic address: lwroberts.author@gmail.com.
authors.forename: Laura Weiss
authors.initials: LW
authors.lastname: Roberts
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States.
authors.forename: Jane Paik
authors.initials: JP
authors.lastname: Kim
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy; D057240:Patient Preference / Q000523:psychology*; D026684:Personal Autonomy; D010865:Pilot Projects; D019727:Proxy / Q000523:psychology*; D012559:Schizophrenia / Q000628:therapy; D012565:Schizophrenic Psychology; D029181:Spirituality; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires; D020458:Third-Party Consent / Q000941:ethics*
keywords: Anxiety and mood disorder; Ethics; Schizophrenia; Surrogate decision-makers