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Surrogate decision maker

Nita Khandelwal, David Benkeser, Norma B Coe, Ruth A Engelberg, J Randall Curtis
RATIONALE: In the intensive care unit (ICU), complex decision-making by clinicians and families requires good communication to ensure care is consistent with patients' values and goals. OBJECTIVES: Assess the economic feasibility of staffing ICUs with a communication facilitator. METHODS: Data from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n=135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker...
September 27, 2016: Annals of the American Thoracic Society
Adam Feltz
An estimated 1 in 4 elderly Americans need a surrogate to make decisions at least once in their lives. With an aging population, that number is almost certainly going to increase. This paper focuses on financial surrogate decision making. To illustrate some of the empirical and moral implications associated with financial surrogate decision making, two experiments suggest that default choice settings can predictably influence some surrogate financial decision making. Experiment 1 suggested that when making hypothetical financial decisions, surrogates tended to stay with default settings (OR = 4...
2016: Spanish Journal of Psychology
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Jonathon Gass, Rachelle E Bernacki, Susan D Block
OBJECTIVE: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates. DESIGN: We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates...
September 14, 2016: Critical Care Medicine
Amber E Barnato, Yael Schenker, Greer Tiver, Mary Amanda Dew, Robert M Arnold, Eduardo R Nunez, Charles F Reynolds
OBJECTIVES: Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU...
September 9, 2016: Critical Care Medicine
Aasim I Padela, Omar Qureshi
The ever-increasing technological advances of modern medicine have increased physicians' capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new "types" of living where a patient's cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care...
September 9, 2016: Medicine, Health Care, and Philosophy
Sarah Adelsperger, Cynthia A Prows, Melanie F Myers, Cassandra L Perry, Ariel Chandler, Ingrid A Holm, John A Lynch
Concerns about the ethical and social implications of genetics persist as more applications of genetic and genomic technology have become available. Pediatric testing for genetic influences on response to opioids like codeine is one area of application. We interviewed parents of children enrolled in a mixed-methods study following the communication of actual or hypothetical results for CYP2D6, which impacts opioid response. Forty-one parents of children naive to opioids and 42 parents of children previously exposed to opioids participated in qualitative interviews...
August 30, 2016: Health Communication
Alexander A Kon, Eric K Shepard, Nneka O Sederstrom, Sandra M Swoboda, Mary Faith Marshall, Barbara Birriel, Fred Rincon
OBJECTIVES: The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided...
September 2016: Critical Care Medicine
Paul J Hutchison, Katie McLaughlin, Tom Corbridge, Kelly N Michelson, Linda Emanuel, Peter H S Sporn, Megan Crowley-Matoka
OBJECTIVE: In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU. DESIGN: Prospective qualitative study. SETTING: Medical ICU of a major urban university hospital...
August 10, 2016: Critical Care Medicine
Allison Tong, Klemens Budde, John Gill, Michelle A Josephson, Lorna Marson, Timothy L Pruett, Peter P Reese, David Rosenbloom, Lionel Rostaing, Anthony N Warrens, Germaine Wong, Jonathan C Craig, Sally Crowe, Tess Harris, Brenda Hemmelgarn, Braden Manns, Peter Tugwell, Wim Van Biesen, David C Wheeler, Wolfgang C Winkelmayer, Nicole Evangelidis, Benedicte Sautenet, Martin Howell, Jeremy R Chapman
BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy...
June 2016: Transplantation Direct
Chi Eung Danforn Lim, Rachel W C Ng, Nga Chong Lisa Cheng, Maria Cigolini, Cannas Kwok, Frank Brennan
BACKGROUND: End-stage kidney disease (ESKD) is a chronic, debilitative and progressive illness that may need interventions such as dialysis, transplantation, dietary and fluid restrictions. Most patients with ESKD will require renal replacement therapy, such as kidney transplantation or maintenance dialysis. Advance care planning traditionally encompass instructions via living wills, and concern patient preferences about interventions such as cardiopulmonary resuscitation and feeding tubes, or circumstances around assigning surrogate decision makers...
July 26, 2016: Cochrane Database of Systematic Reviews
Adam Peña, Trevor Bibler
Mr. M is an eighty-five-year-old who presented to the hospital with congestive heart failure exacerbation, pneumonia, altered mental status, and sepsis. A physician determines that he lacks capacity, and the team in the intensive care unit looks to the patient's daughter, Celia, as his surrogate decision-maker because she is named as an agent in his medical power of attorney form. While in the ICU, Mr. M suffers acute respiratory distress secondary to pneumonia and thus requires intubation. Celia accepts several life-sustaining interventions, but she sporadically refuses other medically indicated therapies...
July 2016: Hastings Center Report
Emily Reeve, Petra Denig, Sarah N Hilmer, Ruud Ter Meulen
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners' prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing...
July 14, 2016: Journal of Bioethical Inquiry
Shannon S Carson, Christopher E Cox, Sylvan Wallenstein, Laura C Hanson, Marion Danis, James A Tulsky, Emily Chai, Judith E Nelson
IMPORTANCE: Family caregivers of patients with chronic critical illness experience significant psychological distress. OBJECTIVE: To determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression. DESIGN, SETTING, AND PARTICIPANTS: A multicenter randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units (ICUs). Adult patients (aged ≥21 years) requiring 7 days of mechanical ventilation were randomized and their family surrogate decision makers were enrolled in the study...
July 5, 2016: JAMA: the Journal of the American Medical Association
Douglas B White
No abstract text is available yet for this article.
July 5, 2016: JAMA: the Journal of the American Medical Association
S Kleijnen, I Lipska, T Leonardo Alves, K Meijboom, A Elsada, V Vervölgyi, A d'Andon, A Timoney, H G Leufkens, A De Boer, W G Goettsch
BACKGROUND: There is a debate on the added clinical value of new, expensive, anticancer treatments. Among European decision makers, the relevance of commonly used end points in trials, especially overall survival (OS), progression-free survival (PFS) and quality of life (QoL), varies, leading to the available evidence being valued differently. This research studies the extent to which the value of end points for cancer medicines differs among European decision makers. METHODS: We compared guidelines and relative effectiveness assessments (REAs) of medicines for pricing or reimbursement decisions in England, France, Germany, The Netherlands, Poland, and Scotland...
September 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Mi-Kyung Song, Maureen Metzger, Sandra E Ward
BACKGROUND: Few studies have examined the process and impact of an advance care planning intervention experienced by surrogate decision-makers of dialysis patients. AIM: To explore the perspectives of the bereaved surrogates of dialysis patients on the process and impact of an advance care planning intervention and to compare the perceived impacts of the intervention between African Americans and Whites. DESIGN: Qualitative interviews and thematic analysis...
June 6, 2016: Palliative Medicine
Jillian L Gustin, David P Way, Sharla Wells-Di Gregorio, Jennifer W McCallister
RATIONALE: Fellows in pulmonary and critical care medicine are required to show competency in facilitating family meetings for critically ill patients. There are many assessment measures available for evaluating physician-patient communication (e.g., the SEGUE Framework [Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter]) and some designed for family meetings. However, no validated measure exists that is specifically designed to assess communication skills during family meetings with surrogate decision makers in intensive care settings...
August 2016: Annals of the American Thoracic Society
Stacy Y Chu, David Y Hwang
Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particular, early predictions of poor outcome for ICH patients routinely influence discussions with surrogate decision makers to pursue do-not-resuscitate orders or comfort care, practices that may often be appropriate, but that are at risk for self-fulfilling prophecies...
June 2016: Seminars in Neurology
Douglas B White, Natalie Ernecoff, Praewpannarai Buddadhumaruk, Seoyeon Hong, Lisa Weissfeld, J Randall Curtis, John M Luce, Bernard Lo
IMPORTANCE: Misperceptions about prognosis by individuals making decisions for incapacitated critically ill patients (surrogates) are common and often attributed to poor comprehension of medical information. OBJECTIVE: To determine the prevalence of and factors related to physician-surrogate discordance about prognosis in intensive care units (ICUs). DESIGN, SETTING, AND PARTICIPANTS: Mixed-methods study comprising quantitative surveys and qualitative interviews conducted in 4 ICUs at a major US medical center involving surrogate decision makers and physicians caring for patients at high risk of death from January 4, 2005, to July 10, 2009...
May 17, 2016: JAMA: the Journal of the American Medical Association
Mats Johansson, Linus Broström
Part of the standard protection of decisionally incapacitated research subjects is a prohibition against enrolling them unless surrogate decision makers authorize it. A common view is that surrogates primarily ought to make their decisions based on what the decisionally incapacitated subject would have wanted regarding research participation. However, empirical studies indicate that surrogate predictions about such preferences are not very accurate. The focus of this article is the significance of surrogate accuracy in the context of research that is not expected to benefit the research subject...
April 2016: Theoretical Medicine and Bioethics
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