A higher proportion of intensive care patients needed surrogate decision-making, but the majority of patients in the study who required a surrogate were admitted to the general medicine wards, suggesting that families are needed to make decisions throughout the hospital. When patients cannot make decisions for themselves due to dementia, delirium or other types of cognitive impairment, physicians turn to surrogate decision-makers, most commonly a close family member. In some instances, a surrogate may have been previously designated by the patient who completed a Health Care Power of Attorney form, but in many cases the individual is not fully informed about the patient’s wishes.
Surrogates are asked to make decisions in critical areas including code status, ventilators and other life-prolonging therapies, surgery options, and post-hospital placement. All are vital to the patient’s care and outcome. Th e presence of a surrogate requires fundamental changes in the way clinicians communicate and make decisions for patient, according to the study authors. “Many hospitals treat family members as visitors rather than as members of the patient’s health care team,” Dr. Torke said. “In-depth interviews with surrogates conducted as part of my ongoing research has found that surrogates often have trouble contacting hospital staff and struggle for information about the patient.
Clinicians also reporting on a study from the University of Pennsylvania. frequently report making decisions with surrogates to be highly stressful.” Th e study authors call for redesign of hospital functions to account for the large and growing role of surrogates and to provide support for surrogates as they make health care decisions. Source: “Scope and Outcomes of Surrogate Decision-Making Among Hospitalized Older Adults” was published in the March 2014 issue of JAMA Internal Medicine. Th e study was supported, in part, by the National Institute on Aging and by the John A. Hartford Foundation.