Patient Beliefs and Preferences Regarding Surrogate Decision Makers

Area of Science:

• Medical Ethics
• Patient Autonomy
• Healthcare Law

Background:

• Patients often lose decision-making capacity due to severe illness, sedation, or anesthesia.
• In the U.S., next of kin (NOK) is typically the default surrogate decision-maker (SDM).
• Default SDM designation may not align with patient preferences.

Purpose of the Study:

• To assess the congruence between a patient's preferred SDM and the default NOK.
• To determine patient awareness of who would serve as their SDM if incapacitated.

Main Methods:

• Cross-sectional survey design.
• Assessed patient beliefs about who would make decisions on their behalf.
• Examined the relationship between preferred SDM and NOK.

Main Results:

• 18% of patients believed someone other than NOK would be chosen as SDM.
• 20.3% of all participants preferred an SDM other than their NOK.
• 9.3% of married participants preferred an SDM other than their NOK.

Conclusions:

• A significant number of patients are unaware of potential discrepancies in SDM designation.
• Providers should proactively inquire about patient SDM preferences.
• Encouraging healthcare proxy designation can improve alignment with patient wishes.