Surrogate Decision-Making After Stroke in a Community Setting: The OASIS Project.

Area of Science:

• Neurology
• Health Services Research
• Health Disparities

Background:

• Severe stroke necessitates surrogate decision-makers for critical treatment choices.
• Ethnic variations in healthcare experiences among surrogate decision-makers are not well understood.
• The Outcomes Among Surrogate Decision Makers in Stroke (OASIS) project examines these disparities.

Purpose of the Study:

• To investigate ethnic differences in physician communication quality and shared decision-making.
• To compare experiences between Mexican American (MA) and non-Hispanic White (NHW) surrogate decision-makers for stroke patients.
• To identify potential disparities in surrogate experiences during end-of-life care decisions.

Main Methods:

• Analysis of data from the OASIS study involving patients with ischemic stroke or intracerebral hemorrhage.
• Surrogates self-reported involvement in life-sustaining treatment decisions.
• Comparison of physician communication quality (scale score) and shared decision-making (CollaboRATE scale) between MA and NHW surrogates using regression analyses.
• Adjustments for demographics, clinical factors, and confounders were applied.

Main Results:

• A total of 320 surrogates (158 MA, 85 NHW) were included in the study.
• MA surrogates reported higher quality of communication compared to NHW surrogates, though the difference was attenuated after adjusting for trust and prayer frequency.
• High shared decision-making scores were more prevalent in MA surrogates, particularly among older patients, persisting after demographic and clinical adjustments.

Conclusions:

• Surrogate decision-makers for Mexican American stroke patients generally reported superior outcomes in communication quality and shared decision-making compared to NHW individuals.
• Findings suggest potential ethnic disparities in surrogate experiences during severe stroke care.
• Further research into diverse surrogate populations can identify strengths and resilience factors applicable across different groups.