McDade-Montez Elizabeth, Watson David, Beer Andrew
Psychological Sciences Program, University of California Merced.
Department of Psychology, University of Notre Dame.
Fam Syst Health. 2013 Dec;31(4):366-81. doi: 10.1037/a0033372. Epub 2013 Aug 19.
Medical decisions near the end of life are often made by proxies who can be inaccurate in their judgments of patient preferences. Given that accuracy in surrogate decision making is an important goal in end-of-life decision making, and in light of that previously seen levels of accuracy reflect substantial disagreement, error, or both, this study examined both relationship and individual factors that potentially affect surrogate accuracy. Specifically, this study examined similarity, agreement, and assumed similarity-a process whereby raters use their own traits and preferences to rate another person-in spousal ratings of end-of-life treatment. This study expands on previous research by examining the potential influence of relationship factors and assumed similarity on end-of-life decision making among a sample of newlyweds. Newly married couples (n = 197) completed self and spouse measures of hypothetical end-of-life preferences and scales assessing marital satisfaction, personality, and attitudes. Results indicate a moderate level of similarity on husband and wife self-rated end-of-life treatment preferences (rs = .18-.29) and a moderate level of agreement between self and proxy ratings (rs = .17-.41). The largest correlations were seen between self ratings and proxy ratings (e.g., husband self ratings and husband proxy ratings of wife preferences, rs = .46-.69), reflecting strong assumed similarity in proxy ratings. For wives, similarity with husbands on a few attitudinal variables (i.e., spirituality, moral strictness, and conservatism) influenced proxy accuracy. Recognizing the potential impact of personal preferences on proxy ratings, as well as the potential influence of relationship factors, may help improve proxy accuracy and end-of-life care for patients and families.
临终前的医疗决策通常由代理人做出，而他们对患者偏好的判断可能并不准确。鉴于替代决策的准确性是临终决策的一个重要目标，并且鉴于之前所观察到的准确性水平反映出存在重大分歧、错误或两者皆有，本研究考察了可能影响代理人准确性的关系因素和个体因素。具体而言，本研究考察了相似度、一致性以及假定相似度——即评分者利用自身特质和偏好对他人进行评分的过程——在配偶对临终治疗的评分中的情况。本研究通过考察关系因素和假定相似度对新婚夫妇样本临终决策的潜在影响，对先前的研究进行了拓展。新婚夫妇（n = 197）完成了关于假设的临终偏好的自我及配偶测量，以及评估婚姻满意度、个性和态度的量表。结果表明，夫妻在自评的临终治疗偏好上有中等程度的相似度（rs = 0.18 - 0.29），自我评分与代理人评分之间有中等程度的一致性（rs = 0.17 - 0.41）。自我评分与代理人评分之间的相关性最强（例如，丈夫对妻子偏好的自我评分与丈夫作为代理人的评分，rs = 0.46 - 0.69），这反映出代理人评分中存在较强的假定相似度。对于妻子来说，在一些态度变量（即灵性、道德严谨性和保守主义）上与丈夫的相似度影响了代理人的准确性。认识到个人偏好对代理人评分的潜在影响以及关系因素的潜在影响，可能有助于提高代理人的准确性，并改善患者及其家庭的临终护理。
