Surrogates, who make medical decisions on patients' behalf if they are unable to, are often overly confident in their ability to make treatment decisions according to that patient's wishes, according to a study published in JAMA Internal Medicine.
The study, conducted by researchers at the Yale School of Medicine in New Haven, Conn., assessed surrogates' level of confidence in their knowledge of patients' preferences via interviews with 349 veterans getting primary care in the VA Connecticut Healthcare System.
The veterans were asked to choose whether three health states that could happen after treatment were acceptable or unacceptable to them — severe physical disability, severe cognitive disability and severe pain. The surrogates were then asked to rate as they thought the patient would and say how confident they felt in making a decision that represents the patient's views.
Although 75 percent of surrogates said they felt extremely confident in their ability to make treatment decisions according to the patient's wishes, only 21 percent of surrogates knew the patients' ratings for all health states.
"It's important for clinicians to educate the patient on the need to sit down and talk to a loved one and to refer to existing tools or written materials. The clinician can provide any number of sources of information," study author Terri Fried, MD, told the Yale Daily News. "These conversations can't happen in a 20-minute primary care visit — these are in-depth discussions and happen at the kitchen table."
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