Survey finds physicians do not always rely solely on expressed patient preferences
WEDNESDAY, March 31 (HealthDay News) -- Physicians making medical decisions for patients unable to decide for themselves often include factors other than expressed patient preferences in their decisions, even though most physicians consider those preferences their most important guideline, according to a study in the March issue of the Journal of the American Geriatrics Society.
Alexia M. Torke, M.D., of the Indiana University Center for Aging Research in Indianapolis, and colleagues surveyed 281 physicians about their experience caring for incapacitated patients unable to make medical decisions. The physicians were asked to rate the factors influencing their decisions for such patients.
Overall, the researchers found that 72.6 percent of the physicians said the most important ethical standard for surrogate decision-making was related to patient preference, and 73.3 percent had reported recently making a surrogate decision. Of the physicians recently making a surrogate decision, patient preferences were reported as highly important in decision-making for 81.8 percent; however, only 29.4 percent reported that patient preference was the most important factor. Intensive-care status increased the likelihood that surrogate decisions were based on patient preference (odds ratio, 2.92), while advancing age decreased the likelihood (odds ratio, 0.76 per decade of age). Furthermore, living wills and prior patient-physician discussions were not found to be predictors of compliance to patient preferences.
"Even when helpful information about the patient's preferences is available, physicians appear to incorporate other decision making factors that may be at least equally important. This difference between ethical theory and physician practice could encourage us either to compel physicians to weigh patient preferences more heavily in surrogate decision making or to consider whether the ethical framework for surrogate decisions should be modified to allow for balancing of multiple decision making factors," the authors write.
Abstract
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