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Life-sustaining treatment decisions: a social work response to meet needs of health care surrogates
- Authors:
- BUCKEY Julia W., ABELL Neil
- Journal article citation:
- Journal of Social Work in End-of-Life and Palliative Care, 6(1-2), January 2010, pp.27-50.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
It is estimated that surrogates potentially influence nearly 1.5 million end-of-life treatment decision per year in the US. Surrogates must possess essential patient information prior to legitimately exercising legal and moral obligations to act on patient’s medical care preferences. The authors discuss the development of surrogate roles and responsibilities and describe a cross-sectional study which examined factors influencing surrogate and proxy decisions following life-sustaining treatment decisions. Surrogacy was considered to refer to a responsible adult who had not been expressly designated to make health care decisions for a particular incapacitated individual, but who was authorised to do so by law. One hundred and thirty two adults currently acting as surrogate and proxy for critically ill patients completed surveys immediately after their decision about a life-sustaining treatment and, where possible, before those decisions had been acted upon or their outcomes known. The average surrogate age was 58 years, 78.8% were female, and 82.5% were white. Spouses were the largest relationship group (37.1%). Of the respondents, 48.5% withheld or did not begin treatment. Patient communication and self-efficacy variables accounted for approximately 38% of the variance in surrogates’ perceptions of benefits/barriers associated with decision making. Guided by patient’s advance communication respondents (97.8%) expressed high self-reliance and significant appreciation of benefits associated with their decisions. Implications for social work practice are discussed. The authors comment that clarifying surrogates and providers understanding of patient care preferences during ICU/CCU admission may facilitate better adherence to patient wishes.