Background Surrogate medical decision-making at the end of life is common and the patient’s partner is often the person who must make these critical decisions. The challenge of surrogate medical decision-making is to make decisions that best fit the patient‘s wishes. This study investigates subjective and objective knowledge of partner’s preferences for the end of life, as well as the contribution of partner’s advance care planning (ACP) to this knowledge in a nationally representative sample of older adult (58+) couples living in Switzerland (N=592).
Methods Subjective knowledge is based on self-rated awareness of partner’s EOL preferences for the end of life. Objective knowledge is assessed by two standardized scores that are the sum of correct responses on partner preferences regarding eleven EOL care aspects and three medical treatments. The contribution of EOL discussion and ACP to subjective and objective knowledge of partner’s preferences for the end of life is examined using regression models.
Results The vast majority of respondents thought they knew their partner’s wishes for end of life (subjective knowledge). The proportion of wrong predictions of partner’s preferences for the eleven EOL care aspects (objective knowledge) varied between 6.5% and 45%, and for the three medical treatments between 11.5% and 34.5%. Respondents whose partner discussed their EOL preferences with them, completed an advance directive and designated them as a healthcare proxy were more likely to report a better subjective knowledge. Respondents whose partner completed an advance directive and designated them as a healthcare proxy were more likely to have better objective knowledge of partner’s preferences for medical treatments.
Conclusion Being a couple is not enough to assess one’s partner’s EOL preferences correctly. Communication about EOL wishes among the couple and individual ACP should be encouraged, as they improve the level of subjective and objective knowledge of partners’ EOL preferences.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.