Featured Research

from universities, journals, and other organizations

Numerous factors weighed when patients cannot make their own decisions

Date:
March 22, 2010
Source:
Indiana University School of Medicine
Summary:
A new study found that when asked to identify the single most important factor in making decisions for their patients lacking the capability to make their own decisions, physicians most commonly reported "what was best for the patient overall" (33 percent), "what the patient would have wanted you to do" (29 percent), "the patient's pain and suffering" (13 percent), and "the patient's prognosis" (12 percent).

Living wills and surrogate decision makers account for only a portion of the many factors weighed by physicians when making medical decisions for hospitalized patients lacking the capability to make their own decisions, according to a recently published study.

Related Articles


Researchers who queried 281 physicians report their conclusions in a study that appears in the March 2010 issue of the Journal of the American Geriatrics Society.

"A growing number of hospitalized adults are incapable of making their own health decisions," said Alexia Torke, M.D., senior author of the study. "Doctors balance a lot of important considerations when caring for a patient who cannot voice his or her own preferences. These considerations include what the patient would have wanted and what the physician and family think is best for the patient overall. While prior discussions or living wills may be helpful especially in circumstances when the patient expressed strong beliefs and is facing a difficult illness, these preferences are only part of the equation." Dr. Torke is an assistant professor of medicine at the Indiana University School of Medicine, a Regenstrief Institute investigator, and an IU Center for Aging Research scientist.

The study surveyed 281 internists, family practice doctors, intensive care unit physicians and hospitalists, about half of whom were in private practice. Slightly over half were male. Each was asked questions about caring for their most recent patient who was unable to make his or her own decisions and rated the importance of each of the factors that influenced decisions on how to care for the patient.

The researchers found that when asked to identify the single most important factor in making decisions for their patient, physicians most commonly reported "what was best for the patient overall" (33 percent), "what the patient would have wanted you to do" (29 percent), "the patient's pain and suffering" (13 percent), and "the patient's prognosis" (12 percent).

"Even though standard ethical models say that patient preferences should be the most important factor in surrogate decision making, in reality doctors consider many factors and weight them differently in each case," said Dr. Torke.

"We have come to consensus in our society that people should have a lot of input into their own medical decisions. But when the patient can't made decisions we have much less consensus on how to proceed. While physicians weigh various factors, we learned from our study that what's going on at the time the treatment decision is being made is as important as previous medical directives. We did not find evidence that living wills or prior discussions with patients about their preferences for care made a difference in the decision making for most patients," she said.

"We also found a decreased reliance on patient preferences with increasing age. This may reflect ageist assumptions that the preferences and values of older adults are less important than those of younger adults. Another possible explanation is that when caring for older adults, physicians may accept that death is an unavoidable event and that for many patients, health care in advanced age should focus more on quality of life than extension of life," said Dr. Torke, who is also affiliated with the Fairbanks Center for Medical Ethics at Clarian Health.

In a study published last year in the Journal of General Internal Medicine, Dr. Torke and colleagues found that one in five of the same doctors surveyed for the new study are not comfortable working with a surrogate decision maker. The doctors reported ineffective communication, lack of satisfaction with the outcome of the decision, and an increase in stress level as a result of the surrogate decision making process.

The new JAGS study was funded by the Department of Health and Human Services' Health Resources Services Administration. Co-authors are Mark Siegler, M.D., Rachael M. Moloney, B.A., and G. Caleb Alexander, M.D., of the University of Chicago, and Anna Abalos, M.D., of Rocklin, California.


Story Source:

The above story is based on materials provided by Indiana University School of Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Alexia M. Torke, Rachael Moloney, Mark Siegler, Anna Abalos, G. Caleb Alexander. Physicians' Views on the Importance of Patient Preferences in Surrogate Decision-Making. Journal of the American Geriatrics Society, 2010; 58 (3): 533 DOI: 10.1111/j.1532-5415.2010.02720.x

Cite This Page:

Indiana University School of Medicine. "Numerous factors weighed when patients cannot make their own decisions." ScienceDaily. ScienceDaily, 22 March 2010. <www.sciencedaily.com/releases/2010/03/100322111950.htm>.
Indiana University School of Medicine. (2010, March 22). Numerous factors weighed when patients cannot make their own decisions. ScienceDaily. Retrieved April 1, 2015 from www.sciencedaily.com/releases/2010/03/100322111950.htm
Indiana University School of Medicine. "Numerous factors weighed when patients cannot make their own decisions." ScienceDaily. www.sciencedaily.com/releases/2010/03/100322111950.htm (accessed April 1, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Wednesday, April 1, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

7-Year-Old Girl Gets 3-D Printed 'robohand'

7-Year-Old Girl Gets 3-D Printed 'robohand'

AP (Mar. 31, 2015) — Although she never had much interest in prosthetic limbs before, Faith Lennox couldn&apos;t wait to slip on her new robohand. The 7-year-old, who lost part of her left arm when she was a baby, grabbed it as soon as it came off a 3-D printer. (March 31) Video provided by AP
Powered by NewsLook.com
Solitair Device Aims to Takes Guesswork out of Sun Safety

Solitair Device Aims to Takes Guesswork out of Sun Safety

Reuters - Innovations Video Online (Mar. 31, 2015) — The Solitair device aims to take the confusion out of how much sunlight we should expose our skin to. Small enough to be worn as a tie or hair clip, it monitors the user&apos;s sun exposure by taking into account their skin pigment, location and schedule. Matthew Stock reports. Video provided by Reuters
Powered by NewsLook.com
Soda, Salt and Sugar: The Next Generation of Taxes

Soda, Salt and Sugar: The Next Generation of Taxes

Washington Post (Mar. 30, 2015) — Denisa Livingston, a health advocate for the Dinι Community Advocacy Alliance, and the Post&apos;s Abby Phillip discuss efforts around the country to make unhealthy food choices hurt your wallet as much as your waistline. Video provided by Washington Post
Powered by NewsLook.com
UnitedHealth Buys Catamaran

UnitedHealth Buys Catamaran

Reuters - Business Video Online (Mar. 30, 2015) — The $12.8 billion merger will combine the U.S.&apos; third and fourth largest pharmacy benefit managers. Analysts say smaller PBMs could also merge. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins