Accuracy of surrogate decision making in elective surgery.

Accuracy of surrogate decision making in elective surgery. Research Abstract Details 

Research Abstract Table of Contents

Jump to the:

Accuracy of surrogate decision making in elective surgery. Abstract Text:

Anand V Mantravadi,Bhavna P Sheth,Russell S Gonnering,Douglas J Covert,Anand V Mantravadi,Bhavna P Sheth,Russell S Gonnering,Douglas J Covert,Anand V Mantravadi,Bhavna P Sheth,Russell S Gonnering,Douglas J Covert,

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.

Accuracy of surrogate decision making in elective surgery. Publishing Authors By Initials

AV Mantravadi,BP Sheth,RS Gonnering,DJ Covert,AV Mantravadi,BP Sheth,RS Gonnering,DJ Covert,AV Mantravadi,BP Sheth,RS Gonnering,DJ Covert,

For similar abstracts research abstracts see: abstracts research

PUBMED ID PMID:

MEDLINE DATE:

Accuracy of surrogate decision making in elective surgery. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Journal of cataract and refractive surgery

VOLUME: 33

Page Numbers: 2091-7

Journal Abbreviation:

ISSN: 0886-3350

DAY: 6

MONTH: Dec

YEAR: 2007

Accuracy of surrogate decision making in elective surgery. Information

Number of References:

LANGUAGE: eng

NlmUniqueID: 8604171

Accuracy of surrogate decision making in elective surgery. Keywords Mesh Terms:

KEYWORDS:

MESH TERMS:

Chemical & Substance for Abstract: Accuracy of surrogate decision making in elective surgery. Information

Substance Name:

Registry Number:

Grant and Affiliation Information for Accuracy of surrogate decision making in elective surgery.

AFFILIATION: Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Country: United States

AGENCY:

GRANT:

ACRONYM:

MEDLINETA: J Cataract Refract Surg

REFSOURCE:

DATABASENAME:

ACCESSION NUMBER:

Number Hits: 0

Accuracy of surrogate decision making in elective surgery Related Publications

• Accuracy of surrogate decision making in elective surgery.
• Epithelial ingrowth after Descemet-stripping automated endothelial keratoplasty.
• Response to prostaglandin E1 in neonates with intracranial arteriovenous malformation treated for suspected congenital heart disease.
• Simulation-based education: what's in it for nurse anesthesia educators?
• The Relation of Law to Medicine.
• The effect of colored crowding bars on the HOTV visual acuity test in amblyopic patients.
• The microbiological flora of the Gemini IX spacecraft before and after flight. NASA CR-972.
• Vitamin K control of the increased hypoprothrombinemic effect of dicumarol in congestive heart failure.