How do surrogates make treatment decisions for patients with dementia: An experimental survey study

IF 2 3区 医学 Q2 ECONOMICS
Health economics Pub Date : 2024-02-15 DOI:10.1002/hec.4810
Lauren Hersch Nicholas, Kenneth M. Langa, Scott D. Halpern, Mario Macis
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Abstract

Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making. We conducted a nationally representative experimental survey that cross-randomized cognitive impairment, gender, and characteristics of advance care planning among hospitalized older adults through a series of vignettes. Our study yielded three main findings: first, respondents were much less likely to recommend life-sustaining treatments for patients with dementia, especially after personal exposure. Second, respondents were more likely to ignore patient preferences for life-extending treatment when the patient had dementia, and choose unwanted life-extending treatments for patients without dementia. Third, in scenarios where the patient's wishes were unclear, respondents were more likely to choose treatments that matched their own preferences. These findings underscore the need for improved communication and decision-making processes for patients with cognitive impairment and highlight the importance of choosing a surrogate decision-maker with similar treatment preferences.

代理如何为痴呆症患者做出治疗决定:一项实验调查研究。
尽管老年人对代理决策的需求日益增长,但人们对代理如何做出决策以及预先医疗指示是否会改变决策却知之甚少。我们进行了一项具有全国代表性的实验调查,通过一系列小故事对住院老年人的认知障碍、性别和预先护理计划的特征进行了交叉随机分析。我们的研究得出了三个主要结论:首先,受访者不太可能向痴呆症患者推荐维持生命的治疗方法,尤其是在亲身经历之后。第二,当患者患有痴呆症时,受访者更有可能忽视患者对延长生命治疗的偏好,而为没有痴呆症的患者选择不需要的延长生命治疗。第三,在病人意愿不明确的情况下,受访者更倾向于选择符合自己偏好的治疗方法。这些发现强调了改善认知障碍患者的沟通和决策过程的必要性,并突出了选择具有相似治疗偏好的代理决策者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health economics
Health economics 医学-卫生保健
CiteScore
3.60
自引率
4.80%
发文量
177
审稿时长
4-8 weeks
期刊介绍: This Journal publishes articles on all aspects of health economics: theoretical contributions, empirical studies and analyses of health policy from the economic perspective. Its scope includes the determinants of health and its definition and valuation, as well as the demand for and supply of health care; planning and market mechanisms; micro-economic evaluation of individual procedures and treatments; and evaluation of the performance of health care systems. Contributions should typically be original and innovative. As a rule, the Journal does not include routine applications of cost-effectiveness analysis, discrete choice experiments and costing analyses. Editorials are regular features, these should be concise and topical. Occasionally commissioned reviews are published and special issues bring together contributions on a single topic. Health Economics Letters facilitate rapid exchange of views on topical issues. Contributions related to problems in both developed and developing countries are welcome.
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