Surrogates Often Misunderstand Patient Preferences

Participation of a surrogate in medical care decision making is particularly helpful when the surrogate has an accurate understanding of the patient's wishes. Researchers asked 349 patients in the Veterans Affairs healthcare system to identify surrogates whom they would designate to make medical decisions if they were unable to do so. Patients and their surrogates were asked separately to rate three potential consequences of medical treatment as acceptable or unacceptable to the patient: (1) physical disability (bedbound and requiring assistance for basic needs); (2) cognitive disability (unable to recognize family members); and (3) daily pain “as severe as a broken bone or appendicitis.” Surrogates also were asked about their level of conf…