Chest
Original ResearchCritical Care MedicineSurrogate Decision Makers' Responses to Physicians' Predictions of Medical Futility
Section snippets
Materials and Methods
Between June 2006 and March 2007, we conducted a multicenter, mixed qualitative and quantitative study in three hospitals in California, including a Veterans Affairs hospital, a tertiary academic hospital, and a public county hospital. All study procedures were approved by the institutional review board at each participating hospital.
Study investigators identified eligible surrogates of patients who were critically ill by screening 1 day per week at each institution with a systematic sampling
Participant Characteristics
Of 58 eligible surrogates, 50 were included in the study, for an enrollment rate of 86%. Their demographic characteristics are described in Table 2. For nine patients, we enrolled two individuals who indicated that they were sharing responsibilities for surrogate decision making; for four patients, three individuals indicating that they were sharing responsibility were enrolled into the study. Table 3 describes the patients' demographic characteristics.
Surrogates' Attitudes About Predicting Physiologic Futility
Sixty-four percent of surrogates expressed
Discussion
Our findings provide new insight about the perspectives of surrogate decision makers on the medical futility rationale and point to practical considerations that may help to refine how physicians approach discussions about futility with surrogates. Most surrogates we interviewed were reluctant to immediately accept physicians' predictions of medical futility. We identified several explanations for this finding, including beliefs that individual physicians' predictions may be unreliable, a need
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This project was supported by a grant from the University of California, Berkeley-University of California, San Francisco Joint Medical Program (Mr. Zier), a grant from the University of California, San Francisco Dean's Office Medical Student Research Program (Mr. Zier), and a grant from the National Center for Research Resources [KL2 RR024130], a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research (Dr. White). Dr. White is also supported by a grant from the Greenwall Foundation Faculty Scholars Program.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).