Discussing Patient Values, Goals, and Preferences During Surrogate Decision Making

Area of Science:

• Medical Communication
• Bioethics
• Health Services Research

Background:

• Eliciting patient values and preferences is crucial for surrogate decision-making.
• Effective communication strategies for clinicians to guide surrogates are not well-understood.

Purpose of the Study:

• To identify effective clinician questions for eliciting patient values, goals, and preferences from surrogates.
• To analyze how surrogates respond to different types of clinician inquiries during treatment decision-making.

Main Methods:

• Audio recording of 27 clinician-surrogate conversations.
• Conversation analysis to examine communication patterns and content.
• Qualitative analysis of surrogate responses to clinician questions.

Main Results:

• Clinicians rarely asked direct questions about patient values or goals.
• Questions about what the patient "would say" or find acceptable in specific decisions elicited patient values.
• Broad questions about the patient's life or enjoyment were less effective in revealing decision-relevant values.

Conclusions:

• Clinicians should employ multiple, specific questions to effectively elicit patient values from surrogates.
• Connecting stated patient values directly to treatment decisions is essential for patient-centered care.
• Asking what a patient would find acceptable for a specific treatment decision is a key strategy.