The Accuracy of Surrogate Decision Makers

摘要: Background Clinicians currently rely on patient-designated and next-of-kin surrogates to make end-of-life treatment decisions for incapacitated patients. Surrogates are instructed use the substituted judgment standard, which directs them decision that patient would have made if he or she were capacitated. However, commentators questioned accuracy with predict patients' pREFERENCES. Methods A systematic literature search was conducted using PubMed, Cochrane Library, manuscript REFERENCES, identify published studies provide empirical data how accurately pREFERENCES efficacy of commonly proposed methods improve surrogate accuracy. Two us (D.I.S. D.W.) reviewed all articles extracted hypothetical scenarios used assess percentage agreement between patients surrogates. Results The identified 16 eligible studies, involving 151 2595 surrogate-patient pairs, collectively analyzed 19 526 patient-surrogate paired responses. Overall, predicted 68% Neither designation nor prior discussion improved surrogates' predictive Conclusions Patient-designated incorrectly in one third cases. These undermine claim reliance is justified by their ability Future should whether other mechanisms might more accurately. Also, they offers and/or families benefits independent decisions.