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. 2012 Apr;15(4):412-7.
doi: 10.1089/jpm.2011.0330. Epub 2012 Apr 2.

End-of-life decision-making confidence in surrogates of African-American dialysis patients is overly optimistic

Mi-Kyung Song  1 , Sandra E Ward, Feng-Chang Lin
Affiliations

End-of-life decision-making confidence in surrogates of African-American dialysis patients is overly optimistic

Mi-Kyung Song et al. J Palliat Med. 2012 Apr.

Abstract

Background: Recent studies suggest that surrogate decision makers may be too optimistic about their end-of-life decision making abilities for loved ones. We examined surrogates' decision making confidence with an emphasis on its linkages to their understandings of patients' values and goals for end-of-life care.

Methods: We used baseline data from a randomized trial with 58 dyads of African-American dialysis patients and their surrogates who separately completed the Values of Life-Sustaining Treatment Outcomes and the Goals of Care documents. Surrogates also completed a Surrogate Decision Making Confidence Scale.

Results: Overall, 60% of surrogates were unsure how their loved ones would feel about continuing life-sustaining treatment, including dialysis, in at least one of the four outcomes presented in the Values of Life-Sustaining Treatment Outcomes. For goals of care near end of life, 67.2% to 69.0% of patients preferred comfort care only, but only 20 (34.5%) surrogates were congruent with patients on Goals of Care. Nonetheless, surrogates' confidence was high (M=3.23 out of 4.0). Surrogates' confidence was positively associated with dyad congruence in values for life-sustaining treatment at only a small magnitude (Spearman's rho=.31, p=.02), but not with dyad congruence in goals of care (χ(2)=2.13, df=1, p=.19).

Conclusions: Surrogates' confidence had little association with their actual understanding of patients' values and goals. Interventions to prepare patients and surrogates for end-of-life decision making may need to address overconfidence and help surrogates recognize their limited understanding of patients' values and goals.

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Figures

FIG. 1.
FIG. 1.
Number (%) of patient preferences and surrogate predictions of values for life-sustaining treatment outcomes.
FIG. 2.
FIG. 2.
Number (%) of patients' preferences and surrogates' predictions of goals of care near end of life.
See this image and copyright information in PMC

References

    1. U.S. Renal Data System. USRDS 2010 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Vol. 2007. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2010.
    1. Braun UK. Beyth RJ. Ford ME. McCullough LB. Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making. J Gen Intern Med. 2008;23(3):267–274. - PMC - PubMed
    1. Torke AM. Garas NS. Sexson W. Branch WT. Medical care at the end of life: views of African American patients in an urban hospital. J Palliat Med. 2005;8(3):593–602. - PubMed
    1. Mor V. Papandonatos G. Miller SC. End-of-life hospitalization for African American and non-Latino white nursing home residents: Variation by race and a facility's racial composition. J Palliat Med. 2005;8(1):58–68. - PubMed
    1. Phipps E. True G. Harris D. Chong U. Tester W. Chavin SI. Braitman LE. Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers. J Clin Oncol. 2003;21(3):549–554. - PubMed

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