Patient Beliefs and Preferences Regarding Surrogate Decision Makers

Many patients lose the capacity to make medical decisions because of severe illness or the effects of sedation or anesthesia. Most states in the United States designate the next of kin (NOK) as a default surrogate decision maker (SDM), but this may not always reflect patient preferences. Our objective was to determine how frequently the default SDM matched the patient's preferred SDM, and whether patients knew who would serve as their SDM should they become incapacitated.

We used a cross-sectional survey to determine whom patients believed would make decisions on their behalf, patients' relationship to their preferred SDM, how frequently their NOK was their preferred SDM, and how frequently patients' beliefs about SDM determination were accurate.

In total, 18% of patients believed that someone other than their NOK would be asked to make decisions for them; 20.3% of all participants, and 9.3% of married participants, identified someone other than their NOK as their preferred SDM.

A substantial proportion of patients are unaware that someone other than their preferred SDM may be asked to make decisions for them. Providers should explicitly ask patients about their preferences, including whom the patient's preferred SDM would be, and should encourage the patient to designate a healthcare proxy when his or her preferred SDM is not the default SDM designated by local law. Although there are inherent problems with using SDMs, using the person preferred by the patient should result in a greater chance of following the patient's wishes for medical treatment.