Proxy medical decision-making: national survey

Abstract

Objectives: Population ageing and increased care needs lead to adults making consequential medical decisions for others, potentially impacting treatment and end of life. We aim to describe the prevalence of medical decision-making by proxy among the national population and associated demographic and care factors.

Methods: We designed a cross-sectional online survey with a nationally representative adult cohort with an 80% participation rate. 311 Singapore residents completed the survey.

Results: 73% of respondents reported having ever assisted others with medical decisions, while 58% have ever assisted with activities of daily living (ADLs), and 88% with instrumental ADLs (IADLs). Having a digital caregiver account, having a lasting power of attorney as a donee and assisting with ADLs and IADLs are significantly associated with proxy medical decision-making. Gender, ethnicity, income and age did not appear to have a significant impact.

Conclusions: A majority of Singapore adults assist others with caregiving tasks and medical decision-making. These helping behaviours are often performed informally, which may increase decisional burden for caregivers and potential abuse of power.

Keywords: Advance Care Planning; Advance Directives; Clinical decisions; End of life care; Family management; Proxy.