Masashi Tanaka1,2, Kayoko Ohnishi3, Aya Enzo4, Taketoshi Okita4, Atsushi Asai4. 1. Department of Medical Ethics, Tohoku University Graduate School of Medicine, Sendai, Japan. tanakamasashino@gmail.com. 2. Division of Clinical Epidemiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. tanakamasashino@gmail.com. 3. Department of Nursing, Konan Women's University, Kobe, Japan. 4. Department of Medical Ethics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Abstract
BACKGROUND: In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. METHODS: In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. RESULTS: A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. CONCLUSIONS: Surrogate decision-makers based their decisions on important aspects related to a patient's life, and they considered not only the patient's preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.
BACKGROUND: In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. METHODS: In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. RESULTS: A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. CONCLUSIONS: Surrogate decision-makers based their decisions on important aspects related to a patient's life, and they considered not only the patient's preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.
Authors: Rebecca L Sudore; Hillary D Lum; John J You; Laura C Hanson; Diane E Meier; Steven Z Pantilat; Daniel D Matlock; Judith A C Rietjens; Ida J Korfage; Christine S Ritchie; Jean S Kutner; Joan M Teno; Judy Thomas; Ryan D McMahan; Daren K Heyland Journal: J Pain Symptom Manage Date: 2017-01-03 Impact factor: 3.612
Authors: Elizabeth K Vig; Janelle S Taylor; Helene Starks; Elizabeth K Hopley; Kelly Fryer-Edwards Journal: J Am Geriatr Soc Date: 2006-11 Impact factor: 5.562