Communication in advance care planning: Preferences for surrogate involvement

Abstract

Improving the care of persons at the end of their lives is a major priority of medical associations and patient advocacy groups. Central to this effort is the need to better prepare health care surrogates so that they will be able to respect the dying person's wishes if that person loses decision making capacity. But efforts to facilitate communication between dying persons, their surrogates, and health care providers have not been fully successful. We conducted a telephone survey of 174 randomly selected adults from a mid‐sized university community to determine whom people wanted to function as their surrogate, to test the hypothesis that overconfidence in the surrogate's ability may impede communication, and to examine gender differences in communication preferences with surrogates. Spouses were the most frequently selected surrogate, followed by an adult child. Women were more likely to be selected than men were. As expected, persons overestimated their surrogates’ abilities to represent their interests. Two other predictions were not confirmed. Interactions between gender and whether the person was responding as a patient or surrogate were observed. These results confirm the value of applying uncertainty management theories to health issues and lead to recommendations for improving communication between patients and their surrogate decision makers.