Background: Understanding patients’ experiences and wishes is fundamental, especially in the case of geriatric palliative patients. One way to achieve this is to evaluate their wish to die (WTD) and will to live (WTL). However, previous studies have revealed that proxy assessment of the WTD and WTL by health care professionals is difficult and that additional studies are required to guide health care professionals in these assessments.
Objective: This study aimed to explore the proxy assessment of older adults’ WTD and WTL by physicians, medical students, and the general population.
Design: This vignette-based study used three vignettes based on interviews with real patients, along with assessments of the WTD and WTL. Participants rated patients’ WTD and WTL for each vignette. Each proxy assessment was compared with the responses given by the patients described in the vignettes.
Population: Participants were recruited among three populations: 1) physicians, 2) medical students, and 3) lay people outside the health care setting.
Data collected: The following data were collected from each participant: 1) proxy assessment of the WTD (for each vignette); 2) proxy assessment of the WTL (for each vignette); 3) difficulty experienced in proxy assessment (for each vignette); 4) level of confidence in the assessments (overall); 5) general attitude about proxy assessment; and 6) demographic information.
Results: A total of 241 participants completed the survey. Proxy assessment of the WTL varied between the vignettes and the sub-sample of respondents. There was a gap between participants’ evaluations and patients’ answers, with intensity and direction fluctuating between vignettes. Participants reported experiencing moderate difficulty and having moderate confidence in their assessment. Finally, this assessment was described as interesting but difficult due to the participants’ incomplete pictures of the patients.
Conclusions: This study provides a better understanding of the issues related to the proxy assessment of the WTD and WTL. Variation between external and patients’ views indicates the need to openly discuss these topics with patients and further study this issue in situations where patients are no longer able to express their views.