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What would people think? Perceived social norms, willingness to serve as a surrogate, and end-of-life treatment decisions

Published online by Cambridge University Press:  15 July 2020

Rachael Spalding Open the ORCID record for Rachael Spalding [Opens in a new window] ,
JoNell Strough  and
Barry Edelstein
Rachael Spalding*
Affiliation:
Department of Psychology, West Virginia University, MorgantownWV, USA
JoNell Strough
Affiliation:
Department of Psychology, West Virginia University, MorgantownWV, USA
Barry Edelstein
Affiliation:
Department of Psychology, West Virginia University, MorgantownWV, USA
*
Author for correspondence: Rachael Spalding, Department of Psychology, West Virginia University, Morgantown, WV26505, USA. E-mail: rls0046@mix.wvu.edu
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Abstract

Background

Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options.

Method

An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments.

Results

Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments.

Significance of results

The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making — the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates’ confidence in their decisions.

Keywords

DeathEnd-of-lifeMedical decision makingSurrogate decision makingTreatment preferences
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 1 , February 2021 , pp. 46 - 54
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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