In MinnPost, Susan Perry discusses a JAMA Internal Medicine study that found that, within 48 hours of being hospitalized, almost half of adults aged 65 or older needed someone else to help them make one or more decisions, while only 25% had documents prepared to guide what those decisions should be and who should make them. Yet when seniors do have advance directives, doctors often don’t like it.
Common decisions involved resuscitation orders, tests, operations and discharge planning. MinnPost also provides an extensive interview with the lead author, Indiana University School of Medicine’s Dr. Alexia Torke. She said the study found “a very large middle group” where “patients have their mental capacity wax and wane” while in hospital. “So they may be able to participate in a decision one day, and then the next day they become confused and can’t participate… A second possibility is that the patient may have some cognitive impairment and participates in the decision, but the physician really doesn’t think the patient has the ability to make the decision independently. So, it turns out that a kind of three-way communication — one in which there’s a patient, a surrogate decision-maker and a clinician — is actually pretty common. Of course, that kind of communication is even more complicated because there are three people involved.”
Asked if doctors were comfortable in such situations, Torke said, “No. In fact, some of my prior research focused on physician experiences with surrogates. Physicians are not really trained routinely at how to communicate with family members, and they are often uncomfortable [doing so]. I think that’s because communication and decision-making [with surrogates] are more complicated.”
Late-in-life care: the stressful, complicated world of surrogate decision-makers (MinnPost, August 20, 2014)