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Randomized Controlled Trial
. 2018 Jun;35(6):866-874.
doi: 10.1177/1049909117744554. Epub 2017 Nov 29.

A Randomized Controlled Trial of Strategies to Improve Family Members' Preparedness for Surrogate Decision-Making

Michael J Green  1   2 , Lauren J Van Scoy  1   2 , Andrew J Foy  3   4 , Renee R Stewart  1 , Ramya Sampath  5 , Jane R Schubart  3   6 , Erik B Lehman  3 , Anne E F Dimmock  2 , Ashley M Bucher  4 , Lisa S Lehmann  5   7 , Alyssa F Harlow  5 , Chengwu Yang  8 , Benjamin H Levi  1   9
Affiliations
Randomized Controlled Trial

A Randomized Controlled Trial of Strategies to Improve Family Members' Preparedness for Surrogate Decision-Making

Michael J Green et al. Am J Hosp Palliat Care. 2018 Jun.

Abstract

Objective: To evaluate 2 strategies for preparing family members for surrogate decision-making.

Design: A 2 × 2 factorial, randomized controlled trial testing whether: (1) comprehensive online advance care planning (ACP) is superior to basic ACP, and (2) having patients engage in ACP together with family members is superior to ACP done by patients alone.

Setting: Tertiary care centers in Hershey, Pennsylvania, and Boston, Massachusetts.

Participants: Dyads of patients with advanced, severe illness (mean age 64; 46% female; 72% white) and family members who would be their surrogate decision-makers (mean age 56; 75% female; 75% white).

Interventions: Basic ACP: state-approved online advance directive plus brochure. Making Your Wishes Known (MYWK): Comprehensive ACP decision aid including education and values clarification.

Measurements: Pre-post changes in family member self-efficacy (100-point scale) and postintervention concordance between patients and family members using clinical vignettes.

Results: A total 285 dyads enrolled; 267 patients and 267 family members completed measures. Baseline self-efficacy in both MYWK and basic ACP groups was high (90.2 and 90.1, respectively), and increased postintervention to 92.1 for MYWK ( P = .13) and 93.3 for basic ACP ( P = .004), with no between-group difference. Baseline self-efficacy in alone and together groups was also high (90.2 and 90.1, respectively), and increased to 92.6 for alone ( P = .03) and 92.8 for together ( P = .03), with no between-group difference. Overall adjusted concordance was higher in MYWK compared to basic ACP (85.2% vs 79.7%; P = .032), with no between-group difference.

Conclusion: The disconnect between confidence and performance raises questions about how to prepare family members to be surrogate decision-makers.

Keywords: advance care planning; family caregivers; self-efficacy; surrogate decision-making.

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Conflict of interest statement

Conflict of Interests: Two of the authors (BHL & MJG) have intellectual property and copyright interests for the comprehensive decision aid used in this study, Making Your Wishes Known: Planning Your Medical Future (MYWK), which is available online free of charge. A version of MYWK that can be widely distributed is currently under development in partnership with a private commercial enterprise.

Figures

Figure 1
Figure 1
Study Design and Consort Flow Chart
Figure 2
Figure 2
Concordance Comparison by Vignette
See this image and copyright information in PMC

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