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Because patients who are critically ill often cannot communicate their wishes, we turn to surrogates to help make treatment decisions. Ideally, we would use the substituted judgment of such surrogates, based on an understanding of the patient's values and preferences, to guide these choices. But how often do we achieve that goal?
Investigators analyzed 244 family meetings during which clinicians and patients' surrogates discussed goals of care for patients with acute respiratory distress syndrome whose estimated mortality was at least 50%. Data were collected from 13 intensive care units in six geographically diverse medical centers. Half the meetings included an attending physician; the remainder had a fellow, resident, or advanced practice…