scholarly journals A Resident-Led Initiative to Increase Documentation of Surrogate Decision Makers for Hospitalized Patients

2019 ◽  
Vol 11 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Jeffrey M. Dueker ◽  
Jacob Luty ◽  
D. Alexander Perry ◽  
Seiko Izumi ◽  
Erik K. Fromme ◽  
...  
Keyword(s):  
Performance Feedback ◽  
Financial Incentive ◽  
Hospitalized Patients ◽  
Decision Makers ◽  
Educational Outreach ◽  
Quality Improvement Initiative ◽  
Intervention Period ◽  
Statistical Process ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

ABSTRACT Background Identification of surrogate decision makers (SDMs) is an important part of advance care planning for hospitalized patients. Despite its importance, the best methods for engaging residents to sustainably improve SDM documentation have not been identified. Objective We implemented a hospital-wide quality improvement initiative to increase identification and documentation of SDMs in the electronic health record (EHR) for hospitalized patients, utilizing a Housestaff Quality and Safety Council (HQSC). Methods EHR documentation of SDMs for all adult patients admitted to a tertiary academic hospital, excluding psychiatry, were tracked and grouped by specialty in a weekly run chart during the intervention period (July 2015 through April 2016). This also continued postintervention. Interventions included educational outreach for residents, monthly plan-do-study-act cycles based on performance feedback, and a financial incentive of a one-time payment of 0.75% of a resident's salary put into the retirement account of each resident, contingent on meeting an SDM documentation target. Comparisons were made using statistical process control and chi-square tests. Results At baseline, SDMs were documented for 11.1% of hospitalized adults. The intervention period included 9146 eligible admissions. Hospital-wide SDM documentation increased significantly and peaked near the financial incentive deadline at 48% (196 of 407 admissions, P < 001). Postintervention, hospital-wide SDM documentation declined to 30% (134 of 446 admissions, P < .001), but remained stable. Conclusions This resident-led intervention sustainably increased documentation of SDMs, despite a decline from peak rates after the financial incentive period and notable differences in performance patterns by specialty admitting service.

scholarly journals Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients

2021 ◽  
pp. 1-11
Author(s):  
Wendy G. Lichtenthal ◽  
Martin Viola ◽  
Madeline Rogers ◽  
Kailey E. Roberts ◽  
Lindsay Lief ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Experiential Avoidance ◽  
Decision Makers ◽  
Post Intervention ◽  
Prolonged Grief ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Peritraumatic Distress

Abstract Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates’ mental health and patient outcomes. Method Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15–20 min modules, totaling 1.5–2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. Results Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = −0.41), peritraumatic distress (d = −0.24), and experiential avoidance (d = −0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = −0.94), depression (d = −0.23), anxiety (d = −0.29), and experiential avoidance (d = −0.30). Significance of results Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.

scholarly journals “It’s not just what the doctor tells me:” Factors that influence surrogate decision-makers’ perceptions of prognosis*

2010 ◽  
Vol 38 (5) ◽  
pp. 1270-1275 ◽  
Author(s):  
Elizabeth A. Boyd ◽  
Bernard Lo ◽  
Leah R. Evans ◽  
Grace Malvar ◽  
Latifat Apatira ◽  
...  
Keyword(s):  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

scholarly journals Impact of a Decision Aid on Surrogate Decision-Makers' Perceptions of Feeding Options for Patients With Dementia

2013 ◽  
Vol 14 (2) ◽  
pp. 114-118 ◽  
Author(s):  
E. Amanda Snyder ◽  
Anthony J. Caprio ◽  
Kathryn Wessell ◽  
Feng Chang Lin ◽  
Laura C. Hanson
Keyword(s):  
Decision Aid ◽  
Decision Makers ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Pension scheme trustees as surrogate decision makers

2021 ◽  
pp. 102043
Author(s):  
Leonardo Weiss-Cohen ◽  
Peter Ayton ◽  
Iain Clacher ◽  
Volker Thoma
Keyword(s):  
Decision Makers ◽  
Pension Scheme ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

We Should Widen Access to Physician-Assisted Death

2021 ◽  
pp. 1-31
Author(s):  
Jordan MacKenzie ◽  
Adam Lerner
Keyword(s):  
Advance Directives ◽  
Terminally Ill ◽  
Decision Makers ◽  
Assisted Death ◽  
Surrogate Decision Makers ◽  
Incapacitated Patients ◽  
Surrogate Decision ◽  
Rule Out

Abstract Typical philosophical discussions of physician-assisted death (“pad”) have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad.

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