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Cited by 24Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareEthics and Legal Issues in Pediatric Healthcare

Surrogate Decision Making: Do We Have to Trade Off Accuracy and Procedural Satisfaction?

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Frey, Renato, Hertwig, Ralph, Herzog, Stefan M.·2014·Medical Decision Making
DOI 10.1177/0272989x12471729
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Abstract

Objective. Making surrogate decisions on behalf of incapacitated patients can raise difficult questions for relatives, physicians, and society. Previous research has focused on the accuracy of surrogate decisions (i.e., the proportion of correctly inferred preferences). Less attention has been paid to the procedural satisfaction that patients’ surrogates and patients attribute to specific approaches to making surrogate decisions. The objective was to investigate hypothetical patients’ and surrogates’ procedural satisfaction with specific approaches to making surrogate decisions and whether implementing these preferences would lead to tradeoffs between procedural satisfaction and accuracy. Methods. Study 1 investigated procedural satisfaction by assigning participants (618 in a mixed-age but relatively young online sample and 50 in an older offline sample) to the roles of hypothetical surrogates or patients. Study 2 (involving 64 real multigenerational families with a total of 253 participants) investigated accuracy using 24 medical scenarios. Results. Hypothetical patients and surrogates had closely aligned preferences: Procedural satisfaction was highest with a patient-designated surrogate, followed by shared surrogate decision-making approaches and legally assigned surrogates. These approaches did not differ substantially in accuracy. Limitations are that participants’ preferences regarding existing and novel approaches to making surrogate decisions can only be elicited under hypothetical conditions. Conclusions. Next to decision making by patient-designated surrogates, shared surrogate decision making is the preferred approach among patients and surrogates alike. This approach appears to impose no tradeoff between procedural satisfaction and accuracy. Therefore, shared decision making should be further studied in representative samples of the general population, and if people’s preferences prove to be robust, they deserve to be weighted more strongly in legal frameworks in addition to patient-designated surrogates.

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  • The inability of clinicians, patients, and caregivers to predict each other's preferences is reported in the treatment decision making literature.

    “The inability of clinicians, patients, and caregivers to predict each other’s preferences is also reported in the treatment decision making literature [7, 37–39].”

    From Development of a decision guide to support the elderly in decision making about location of care: an iterative, user-centered design (2016) · cites this paper as [37]

    The Results (page unavailable) report that family surrogates correctly predicted 68–72% of hypothetical patients’ treatment preferences and cite a previous study in which physicians achieved 65% accuracy. This supports difficulty predicting patients’ preferences, but the paper does not establish that clinicians, patients, and caregivers all have difficulty predicting each other’s preferences. (LLM, conf=0.87)

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Research works printed but not linked: 1

  1. Lang F, Wagner G. Living will incidence in non-clinical popu- lation samples: conditions and reasons for refusal. Deut Med Wochenschr. 2007;132(48):2558-62.

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Authors
Frey, R., Hertwig, R., & Herzog, S. M.
Affiliations
Max Planck Society (DE)
ORCID
Venue
Medical Decision Making
Publisher
SAGE Publications
Published
2013-01-29
Volume
34
Issue
2
Pages
258-269
ISSN
  • 0272-989X (ISSN-L)
  • 1552-681X
DOI
10.1177/0272989x12471729
OpenAlex
W2109216541
Cited by
24
References
47
Citations by year
2026: 1 · 2025: 3 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 1
FWCI
1.71
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Decision Making (publishedVersion)
  • PubMed (publishedVersion)
  • Max Planck Digital Library (submittedVersion, other-oa)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Max Planck Institute for Plasma Physics (submittedVersion)
  • MPG.PuRe (Max Planck Society) (submittedVersion, other-oa)
Funders
Universität Basel
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
Keywords
surrogate decision-making, decision accuracy, incapacitated patients, patient preferences, multigenerational families
MeSH terms
Adolescent, Adult, Aged, Decision Making, Family, Female, Humans, Male, Middle Aged, Mental Competency, Young Adult

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