Surrogate decision making for patients with end-stage dementia.

Détails

ID Serval
serval:BIB_9479F3530A24
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Surrogate decision making for patients with end-stage dementia.
Périodique
International Journal of Geriatric Psychiatry
Auteur⸱e⸱s
Jox R.J., Denke E., Hamann J., Mendel R., Förstl H., Borasio G.D.
ISSN
1099-1166 (Electronic)
ISSN-L
0885-6230
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
27
Numéro
10
Pages
1045-1052
Langue
anglais
Notes
Publication types: Journal Article
Résumé
OBJECTIVE: We aim to explore how health surrogates of patients with dementia proceed in decision making, which considerations are decisive, and whether family surrogates and professional guardians decide differently.
METHODS: We conducted an experimental vignette study using think aloud protocol analysis. Thirty-two family surrogates and professional guardians were asked to decide on two hypothetical case vignettes, concerning a feeding tube placement and a cardiac pacemaker implantation in patients with end-stage dementia. They had to verbalize their thoughts while deciding. Verbalizations were audio-recorded, transcribed, and analyzed according to content analysis. By experimentally changing variables in the vignettes, the impact of these variables on the outcome of decision making was calculated.
RESULTS: Although only 25% and 31% of the relatives gave their consent to the feeding tube and pacemaker placement, respectively, 56% and 81% of the professional guardians consented to these life-sustaining measures. Relatives decided intuitively, referred to their own preferences, and focused on the patient's age, state of wellbeing, and suffering. Professional guardians showed a deliberative approach, relied on medical and legal authorities, and emphasized patient autonomy. Situational variables such as the patient's current behavior and the views of health care professionals and family members had higher impacts on decisions than the patient's prior statements or life attitudes.
CONCLUSIONS: Both the process and outcome of surrogate decision making depend heavily on whether the surrogate is a relative or not. These findings have implications for the physician-surrogate relationship and legal frameworks regarding surrogacy. Copyright © 2011 John Wiley & Sons, Ltd.
Pubmed
Web of science
Création de la notice
04/10/2012 17:02
Dernière modification de la notice
20/08/2019 14:57
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