RESUMO
A growing body of evidence has pointed to the stressful experience surrounding surrogate decision-making on behalf of incapacitated patients. This study (N = 59) asked surrogates to speak about their experiences immediately after having made a life-sustaining treatment decision. Grounded theory analysis revealed four themes: (1) the emotional impact of the decision-making process on the surrogate; (2) the difficulty of watching a loved one's health deteriorate; (3) the importance of having a Living Will (LW) or other written/verbal instructions; and (4) the reliance on spirituality as a means of coping with the surrogate experience. Findings of this study suggest that engaging surrogates at the time of patient admission may be essential in order to clarify patient preferences and strengthen communication between surrogates and the interdisciplinary healthcare team.
Assuntos
Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Cuidadores/psicologia , Tomada de Decisões , Procurador/psicologia , Assistência Terminal/psicologia , Adulto , Anedotas como Assunto , Atitude Frente a Morte , Comunicação , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doente TerminalRESUMO
Surrogates must possess essential patient information prior to legitimately exercising legal and moral obligations to act on patients' medical care preferences. This descriptive, in vivo study examined factors influencing surrogate and proxy decisions (N = 132) following life-sustaining treatment decisions. Patient communication and self-efficacy variables accounted for approximately 38% of the variance in surrogates' perceptions of benefits/barriers associated with decision making. Guided by patients' advanced communication, respondents (97.8%) expressed high self-reliance and significant appreciation of benefits associated with their decisions. Clarifying surrogates' and providers' understanding of patient care preferences during ICU/CCU admission may facilitate better adherence to patient wishes.
Assuntos
Procurador , Serviço Social , Assistência Terminal , Idoso de 80 Anos ou mais , Estudos Transversais , Tomada de Decisões , Família , Feminino , Florida , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Papel Profissional , Autoeficácia , Suspensão de TratamentoRESUMO
Terri Schiavo's life and death placed international focus on social workers' need to better understand and serve health care surrogates and proxies making life-sustaining treatment decisions on behalf of medical patients. This study (N = 132) reports initial validation of a new measure, the Acceptance of Treatment Choice Inventory (ATCI), designed to evaluate benefits and barriers considered by health care surrogates and proxies prior to making a life-sustaining treatment decision about CPR, tube-feedings, dialysis, and ventilation. Affirming a two-factor model with acceptable reliability and preliminary construct validity, surrogates sought decision support and desired to represent patients' wishes adequately.
Assuntos
Tomada de Decisões , Procurador , Inquéritos e Questionários , Suspensão de Tratamento , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Consentimento do Representante LegalRESUMO
Recent advances in health care technology have increased the number of health care decisions made by acute care patients and those who act on their behalf, known as health care surrogates. This study reports on the validation of a new measure, the Health Care Surrogate Preferences Scale. Designed to assess the willingness of adults to perform and convey the duties required to communicate patient preferences, the scale offers a promising tool for use by social workers in health care settings. Development, evaluation, application of the new measure, and future research needs are discussed.