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Surrogate inaccuracy in predicting older adults’ desire for life-sustaining interventions in the event of decisional incapacity: is it due in part to erroneous quality-of-life assessments?

Published online by Cambridge University Press:  06 March 2017

Gina Bravo ,
Modou Sene  and
Marcel Arcand
Gina Bravo*
Affiliation:
Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
Modou Sene
Affiliation:
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada
Marcel Arcand
Affiliation:
Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Quebec, Canada Department of Family Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
*
Correspondence should be addressed to: Gina Bravo, PhD, Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 South Belvedere Street, Sherbrooke Quebec, J1H 4C4, Canada. Phone: +1-819-780-2220, ext. 45244; Fax: +1-819-829-7141. E-mail: Gina.Bravo@USherbrooke.ca.
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Abstract

Background:

Family members are often called upon to make decisions for an incapacitated relative. Yet they have difficulty predicting a loved one's desire to receive treatments in hypothetical situations. We tested the hypothesis that this difficulty could in part be explained by discrepant quality-of-life assessments.

Methods:

The data come from 235 community-dwelling adults aged 70 years and over who rated their quality of life and desire for specified interventions in four health states (current state, mild to moderate stroke, incurable brain cancer, and severe dementia). All ratings were made on Likert-type scales. Using identical rating scales, a surrogate chosen by the older adult was asked to predict the latter's responses. Linear mixed models were fitted to determine whether differences in quality-of-life ratings between the older adult and surrogate were associated with surrogates’ inaccuracy in predicting desire for treatment.

Results:

The difference in quality-of-life ratings was a significant predictor of prediction inaccuracy for the three hypothetical health states (p < 0.01) and nearly significant for the current health state (p = 0.077). All regression coefficients were negative, implying that the more the surrogate overestimated quality of life compared to the older adult, the more he or she overestimated the older adult's desire to be treated.

Conclusion:

Discrepant quality-of-life ratings are associated with surrogates’ difficulty in predicting desire for life-sustaining interventions in hypothetical situations. This finding underscores the importance of discussing anticipated quality of life in states of cognitive decline, to better prepare family members for making difficult decisions for their loved ones.

Trial Registration number:

ISRCTN89993391

Keywords

substitute decision makingproxyhealthcarecognitive impairmentagreementconcordancequality of lifeelderly
Type
Paper of the Month
Information
International Psychogeriatrics , Volume 29 , Issue 7 , July 2017 , pp. 1061 - 1068
Copyright
Copyright © International Psychogeriatric Association 2017 

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