scholarly journals A Scenario-Based Investigation of Surrogate Decision Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Yuxin Zhao ◽  
Benjamin Katz ◽  
Pamela Teaster
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Financial Management ◽  
Self Efficacy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Insurance Company ◽  
Surrogate Decision ◽  
Critically Ill Adults ◽  
Amazon's Mechanical Turk

Abstract Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.

scholarly journals Pathways to and Consequences of Surrogate Decision-Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 702-702
Author(s):  
Pamela Teaster ◽  
Cory Bolkan ◽  
Shawn Meyers
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Elder Abuse ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Protective Services ◽  
Older Americans ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Abstract With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.

scholarly journals Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults

2015 ◽  
Vol 55 (3) ◽  
pp. 765-777 ◽  
Author(s):  
Kristin N. Geros-Willfond ◽  
Steven S. Ivy ◽  
Kianna Montz ◽  
Sara E. Bohan ◽  
Alexia M. Torke
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Religion And Spirituality ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults

2014 ◽  
Vol 174 (3) ◽  
pp. 370 ◽  
Author(s):  
Alexia M. Torke ◽  
Greg A. Sachs ◽  
Paul R. Helft ◽  
Kianna Montz ◽  
Siu L. Hui ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Association of Surrogate Decision-making Interventions for Critically Ill Adults With Patient, Family, and Resource Use Outcomes

2019 ◽  
Vol 2 (7) ◽  
pp. e197229 ◽  
Author(s):  
Lior Bibas ◽  
Maude Peretz-Larochelle ◽  
Neill K. Adhikari ◽  
Michael J. Goldfarb ◽  
Adriana Luk ◽  
...  
Keyword(s):  
Decision Making ◽  
Critically Ill ◽  
Resource Use ◽  
Surrogate Decision Making ◽  
Surrogate Decision ◽  
Critically Ill Adults ◽  
Ill Adults

Financial Surrogate Decision Making: Lessons from Applied Experimental Philosophy

2016 ◽  
Vol 19 ◽  
Author(s):  
Adam Feltz
Keyword(s):  
Decision Making ◽  
Experimental Philosophy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Financial Decisions ◽  
Financial Decision Making ◽  
Recent Debate ◽  
Surrogate Decision Makers ◽  
Financial Decision ◽  
Surrogate Decision

AbstractAn estimated 1 in 4 elderly Americans need a surrogate to make decisions at least once in their lives. With an aging population, that number is almost certainly going to increase. This paper focuses onfinancialsurrogate decision making. To illustrate some of the empirical and moral implications associated with financial surrogate decision making, two experiments suggest that default choice settings can predictably influence some surrogate financial decision making. Experiment 1 suggested that when making hypothetical financial decisions, surrogates tended to stay with default settings (OR = 4.37, 95% CI 1.52, 12.48). Experiment 2 replicated and extended this finding suggesting that in a different context (OR = 2.27, 95% CI 1.1, 4.65). Experiment 2 also suggested that those who were more numerate were less likely to be influenced by default settings than the less numerate, but only when the decision is whether to “opt in” (p= .05). These data highlight the importance of a recent debate about “nudging.” Defaults are common methods to nudge people to make desirable choices while allowing the liberty to choose otherwise. Some of the ethics of using default settings to nudge surrogate decision makers are discussed.

scholarly journals The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

2020 ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Current Status ◽  
Surrogate Decision Making ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Family Preference ◽  
Made In

Abstract Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum ,which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgement grounds in surrogate decision-making involving critical, life-related choices in acute hospitals. Results We interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that does not meet the inclusion criteria. We extracted a total of 4 core categories, 17 categories, 35 subcategories, and 55 codes as an analysis results of interviews regarding the judgment grounds in surrogate decision-making. The four categories are as follows: type 1“Patient preference-oriented factor”, type2“Patient interest-oriented factor”, type3“Family preference-oriented factor”,and type4 “Balanced patient/family preference-oriented factor”. Conclusions This study revealed the current status of surrogate decision-making in Japan: when making decisions about important matters related to a patient’s life, surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. Included in the preferences of surrogate decision-makers were their own views of life and death, their values, and care burden. Given the cultural and social backgrounds in Japan, it remains unclear whether ACP can be properly reflected in judgment grounds in surrogate decision-making. It would be undesirable to base judgments solely on the principle of respect for autonomy or the principles of surrogate decision-making. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted.

scholarly journals Grounds for surrogate decision-making in Japanese clinical practice: a qualitative survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Inclusion Criteria ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Factor Type ◽  
Family Preference

Abstract Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.

Family and Physicians' Views of Surrogate Decision-Making: The Roles and How to Choose

1996 ◽  
Vol 8 (4) ◽  
pp. 589-596 ◽  
Author(s):  
Michel Silberfeld ◽  
Rivka Grundstein-Amado ◽  
Derek Stephens ◽  
Raisa Deber
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Shared Decision ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was geater for families, but that depended to some degree on the diagnosis of the patient.

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