Faculty Collaboration Database

Accuracy of surrogate decision making in elective surgery. J Cataract Refract Surg 2007 Dec;33(12):2091-7

Date

12/07/2007

Pubmed ID

18053910

DOI

10.1016/j.jcrs.2007.07.036

Scopus ID

2-s2.0-36349034472 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

PURPOSE: To assess the accuracy of surrogate decision making for elective cataract surgery.

SETTING: Comprehensive Ophthalmology Department of Tertiary Care Hospital.

METHODS: Decisions regarding elective cataract surgery of currently competent, elderly patients were compared with the predictions of patient-identified surrogate decision makers in scenarios of current state of mental health and progressive dementia. Patients were identified (age >50 years, Mini-Mental Status Score >20, absence of significant noncataract pathology) consecutively at a scheduled clinic visit to a single provider. Preferences for cataract surgery in the current state of health and hypothetical progressive dementia were assessed on a Likert scale. The same interviewer contacted patient-identified surrogate decision makers within 48 hours. Independently, a survey of community ophthalmologists was performed. The concordance of surrogate predictions with patient preferences (32 pairs) was assessed using percentage agreement, the kappa coefficient with dichotomous Likert scale data, and chi-square analyses (concordance beyond chance).

RESULTS: In their current state of health, most patients said they would prefer to have surgery if they were deemed to have a visually significant cataract, which was accurately predicted by surrogates (72% agreement, kappa = 0.65, chi square = 16.5). In a hypothetical dementia scenario, contrary to perceptions of patients and their surrogates, proxies were unable to accurately represent a patient's wishes for elective cataract surgery (34% agreement, kappa = 0.23, chi square = 14.4). Physicians tended to withhold intervention in the dementia scenario.

CONCLUSIONS: The findings suggest that current methods of decision making in elective surgery for patients unable to make autonomous decisions may be seriously flawed. This extends previous findings of inaccuracy with the substituted judgment approach to end-of-life issues to reflect elective surgical scenarios.

Author List

Mantravadi AV, Sheth BP, Gonnering RS, Covert DJ

Author

Bhavna P. Sheth MD Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cataract Extraction
Decision Making
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Reproducibility of Results
Surveys and Questionnaires
Third-Party Consent