Department of Clinical, Health and Educational Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
University of Nottingham, Nottingham, England.
BMC Palliat Care. 2020 Apr 2;19(1):44. doi: 10.1186/s12904-020-00553-w.
A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions.
We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis.
24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors.
Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision.
大量的临终决策是由失去决策能力的患者的近亲做出的。这引发了对代理人如何做出这些决策的调查。实验视角侧重于研究我们为他人做出的决策如何与我们自己的决策不同，而定性视角则探讨了代理人对做出这些决策的见解。
我们进行了一项混合方法研究，将这两种视角结合起来。这对于将决策结果与决策过程进行比较至关重要。我们要求老年伴侣为彼此做出临终决策。然后，他们参加了关于他们决策过程的半结构化访谈。使用主题分析对转录本进行了分析。
24 名参与者参加了这项研究。代理人更有可能冒着降低其伴侣生活质量的风险来采取救生治疗，而不是为自己采取这种治疗。这与他们的记录一致，表明他们希望给他们的伴侣更好的生存机会。尽管在决策任务中有证据表明代理人的判断存在偏差，但参与者压倒性地报告说，他们的意图是做出符合替代判断标准的决策。然而，对他们意愿的不确定性促使他们考虑其他因素。
采用混合方法使我们能够对决策结果和过程进行新的比较。我们发现，代理人的意图大致符合替代判断标准的期望，并且与伴侣的先前讨论有助于他们做出决策。
