Long-term care providers have tough enough jobs, even before any “discussions” with family members might take place.
Now come findings that confirm what many providers have thought for years: Surrogates overwhelmingly don’t know their loved ones’ true care preferences, no matter how confident they sound.
Get a load of the numbers: Just 21% of respondents in a survey of 350 people correctly knew their older family member’s preferences about handling incapacitation. However, a whopping 75% said they were confident that they did, in fact, know the preferences.
Ignorance, meet overconfidence.
Researchers conducted separate interviews with patients 55 and older receiving care through the VA Connecticut Healthcare System and their surrogates, who were mostly family members. They inquired about three outcomes: 1) being bedbound and requiring assistance with activities of daily living such as bathing, dressing, grooming and toileting; 2) being unable to recognize family members; and 3) daily pain feeling like a broken bone or appendicitis.
The patients and surrogates matched answers on single issues a little more than half the time (54% to 59%). But the rate for getting all three situations correct plummeted to just 21%, according to researchers writing in JAMA Internal Medicine online in November.
“Patients and their loved ones actually tend to overestimate how well they’ve talked to each other” about advanced illness care choices, said lead study author Terri Fried, M.D., a professor of medicine at the Yale School of Medicine and an attending physician at the VA Connecticut Health Care System.
The worst part of this is the overconfidence, she added.
The major disconnect often comes from patients wrongly assuming they’ve made their preferences well known.
On the other end of the relationship, a surrogate often mistakes passing comments — perhaps made during a TV show — as rock-solid conversations about personal care preferences when they aren’t.
Fried recommends that surrogates, who were spouses for 52% of the study subjects, discuss a loved one’s preferences multiple times since attitudes can change with age.
Caregivers should gently prod these conversations along, reminding, if necessary, that they will be much more difficult to have in times of crisis.
From the January 01, 2019 Issue of McKnight's Long-Term Care News
