An Empirical Study of Surrogates' Preferred Level of Control over Value-laden Life Support Decisions in Intensive Care Units
Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood. To determine (1) what degree of decisional authority surrogates prefer for value-sensiti...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2011-04, Vol.183 (7), p.915-921 |
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| container_title | American journal of respiratory and critical care medicine |
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| creator | JOHNSON, Sara K BAUTISTA, Christopher A SEO YEON HONG WEISSFELD, Lisa WHITE, Douglas B |
| description | Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood.
To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.
This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.
The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.
Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions. |
| doi_str_mv | 10.1164/rccm.201008-1214oc |
| format | Article |
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To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.
This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.
The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.
Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201008-1214oc</identifier><identifier>PMID: 21037019</identifier><language>eng</language><publisher>New York, NY: American Thoracic Society</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; C. Critical Care ; Clinical death. Palliative care. Organ gift and preservation ; Cohort Studies ; Critical Care - ethics ; Critical Care - methods ; Critical Illness - therapy ; Decision Making - ethics ; Female ; Humans ; Informed Consent ; Intensive care medicine ; Intensive Care Units - ethics ; Life Support Care - ethics ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Professional-Family Relations ; Prospective Studies ; Proxy ; Withholding Treatment - ethics</subject><ispartof>American journal of respiratory and critical care medicine, 2011-04, Vol.183 (7), p.915-921</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Thoracic Society Apr 1, 2011</rights><rights>Copyright © 2011, American Thoracic Society 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c524t-f66eb1de4bc20b49d852264087f69fc365161e275284b0e568db0e8f0981350a3</citedby><cites>FETCH-LOGICAL-c524t-f66eb1de4bc20b49d852264087f69fc365161e275284b0e568db0e8f0981350a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24065654$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21037019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>JOHNSON, Sara K</creatorcontrib><creatorcontrib>BAUTISTA, Christopher A</creatorcontrib><creatorcontrib>SEO YEON HONG</creatorcontrib><creatorcontrib>WEISSFELD, Lisa</creatorcontrib><creatorcontrib>WHITE, Douglas B</creatorcontrib><title>An Empirical Study of Surrogates' Preferred Level of Control over Value-laden Life Support Decisions in Intensive Care Units</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood.
To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.
This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.
The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.
Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>C. Critical Care</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Cohort Studies</subject><subject>Critical Care - ethics</subject><subject>Critical Care - methods</subject><subject>Critical Illness - therapy</subject><subject>Decision Making - ethics</subject><subject>Female</subject><subject>Humans</subject><subject>Informed Consent</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - ethics</subject><subject>Life Support Care - ethics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Professional-Family Relations</subject><subject>Prospective Studies</subject><subject>Proxy</subject><subject>Withholding Treatment - ethics</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkV9rFTEQxRdRbK1-AR8kCNKnrZNsks2-CGWtWrhQoVZ8C9nsbE3ZTa7J7oWCH94s91r_PM3A_M5hZk5RvKRwRqnkb6O10xkDCqBKyigP9lFxTEUlSt7U8Dj3UFcl5823o-JZSncAlCkKT4sjRqGqgTbHxc9zTy6mrYvOmpFcz0t_T8JArpcYw62ZMZ2SzxEHjBF7ssEdjuu4DX6OIbc7jOSrGRcsR9OjJxs3YBZvtyHO5D1al1zwiThPLv2MPrkdktZEJDfezel58WQwY8IXh3pS3Hy4-NJ-KjdXHy_b801pBeNzOUiJHe2Rd5ZBx5teCcYkB1UPshlsJQWVFFktmOIdoJCqz0UN0ChaCTDVSfFu77tdugl7i3l7M-ptdJOJ9zoYp_-dePdd34adrkDJWshscHowiOHHgmnWk0sWx9F4DEvSSlIGXFVNJl__R96FJfp8XYYAMgErxPaQjSGl_N6HVSjoNVq9Rqv30eo12qs2i179fcSD5HeWGXhzAEzKYQ7R-Pz_PxwHKaTg1S89eq4X</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>JOHNSON, Sara K</creator><creator>BAUTISTA, Christopher A</creator><creator>SEO YEON HONG</creator><creator>WEISSFELD, Lisa</creator><creator>WHITE, Douglas B</creator><general>American Thoracic Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110401</creationdate><title>An Empirical Study of Surrogates' Preferred Level of Control over Value-laden Life Support Decisions in Intensive Care Units</title><author>JOHNSON, Sara K ; BAUTISTA, Christopher A ; SEO YEON HONG ; WEISSFELD, Lisa ; WHITE, Douglas B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c524t-f66eb1de4bc20b49d852264087f69fc365161e275284b0e568db0e8f0981350a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>C. Critical Care</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Cohort Studies</topic><topic>Critical Care - ethics</topic><topic>Critical Care - methods</topic><topic>Critical Illness - therapy</topic><topic>Decision Making - ethics</topic><topic>Female</topic><topic>Humans</topic><topic>Informed Consent</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - ethics</topic><topic>Life Support Care - ethics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Professional-Family Relations</topic><topic>Prospective Studies</topic><topic>Proxy</topic><topic>Withholding Treatment - ethics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>JOHNSON, Sara K</creatorcontrib><creatorcontrib>BAUTISTA, Christopher A</creatorcontrib><creatorcontrib>SEO YEON HONG</creatorcontrib><creatorcontrib>WEISSFELD, Lisa</creatorcontrib><creatorcontrib>WHITE, Douglas B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>JOHNSON, Sara K</au><au>BAUTISTA, Christopher A</au><au>SEO YEON HONG</au><au>WEISSFELD, Lisa</au><au>WHITE, Douglas B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Empirical Study of Surrogates' Preferred Level of Control over Value-laden Life Support Decisions in Intensive Care Units</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>183</volume><issue>7</issue><spage>915</spage><epage>921</epage><pages>915-921</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Despite ongoing ethical debate concerning who should control decisions to discontinue life support for incapacitated, critically ill patients, the perspectives of surrogate decision makers are poorly understood.
To determine (1) what degree of decisional authority surrogates prefer for value-sensitive life support decisions compared with more technical biomedical decisions, and (2) what predicts surrogates' preferences for more control over life support decisions.
This was a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death. Surrogates reported their preferred degree of decisional authority using the Degner Control Preferences Scale for two types of decisions: a value-sensitive decision about whether to discontinue life support and a decision regarding which antibiotic to prescribe for an infection.
The majority of surrogates (55%, 127/230; 95% confidence interval, 49-62%) preferred to have final control over the value-sensitive life support decision; 40% (91/230) wished to share control equally with the physician; 5% (12/230) of surrogates wanted the physician to make the decision. Surrogates preferred significantly more control over the value-sensitive life support decision compared with the technical decision about choice of antibiotics (P < 0.0001). Factors independently associated with surrogates' preference for more control over the life support decision were: less trust in the intensive care unit physician, male sex, and non-Catholic religious affiliation.
Surrogates vary in their desire for decisional authority for value-sensitive life support decisions, but prefer substantially more authority for this type of decision compared with technical, medical judgments. Low trust in physicians is associated with surrogates preferring more control of life support decisions.</abstract><cop>New York, NY</cop><pub>American Thoracic Society</pub><pmid>21037019</pmid><doi>10.1164/rccm.201008-1214oc</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE; American Thoracic Society (ATS) Journals Online; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences C. Critical Care Clinical death. Palliative care. Organ gift and preservation Cohort Studies Critical Care - ethics Critical Care - methods Critical Illness - therapy Decision Making - ethics Female Humans Informed Consent Intensive care medicine Intensive Care Units - ethics Life Support Care - ethics Male Medical sciences Middle Aged Multivariate Analysis Odds Ratio Professional-Family Relations Prospective Studies Proxy Withholding Treatment - ethics |
| title | An Empirical Study of Surrogates' Preferred Level of Control over Value-laden Life Support Decisions in Intensive Care Units |
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