Nearly half of the medical treatments and orders for incapacitated, hospitalized elders do not match up with their surrogate decision-makers’ wishes, according to a recent study.
In fact, the most common dispute involves aggressive care when a surrogate prefers comfort measures only or intermediate care, the researchers reported. This can be a problem when the default code status in hospitals is “full code,” they contend.
Notably, nursing home residents transferred to hospitals are more likely to receive care that aligns with the surrogate’s stated goals, compared with elders who are transferred from home settings, the researchers say.
“The longer time frame of nursing facility admissions may allow for higher quality discussions, or facilities may have a more standard approach to addressing code status uniformly,” said Alexia Torke, M.D., from the Regenstrief Institute and Indiana University School of Medicine.
Still, the overall amount of discord is concerning, especially during the COVID-19 crisis, said Torke.
“[T]hat concern is heightened during the pandemic, as many COVID-19 patients cannot make decisions for themselves because they are on ventilators and sedated,” she said.
The solution? Earlier conversations between patient and surrogate, followed by good communication between surrogate and clinicians, Torke concluded.
“This is not TV or the movies — only one in eight critically ill patients will survive CPR. Difficult decisions have to be made and they can best be made when the surrogate knows the patient’s wishes and has successful two-way communication with the care team.”
The study was published in JAMA Network Open.
