Type of Document	Dissertation
Author	Buckey, Julia Winchester
Author's Email Address	JWBuckey@earthlink.net
URN	etd-01052007-164210
Title	Factors Affecting Life-Sustaining Treatment Decisions by Health Care Surrogates and Proxies
Degree	Doctor of Philosophy
Department	Social Work, College of
Advisory Committee	Advisor Name Title Neil Abell Committee Chair Michelle S. Bourgeois Committee Member Nicholas F. Mazza Committee Member
Keywords	Proxy Decisions Surrogate Decision-Making Health Belief Model Health Care Decision-Making
Date of Defense	2006-12-01
Availability	unrestricted
Abstract ABSTRACT This descriptive, nonexperimental, cross-sectional, in vivo study examined factors influencing decisions about life-sustaining treatment decisions (CPR, mechanical ventilation, tube feeding, and hemodialysis), and perceptions of the benefits and barriers associated with these decisions in a central Florida (USA) sample of health care surrogates and proxies (N = 132). Derived from the Health Beliefs Model, a surrogate decision-making model portrayed relationships among study variables assessed with hierarchical multiple regression (HMR). A three-step variable entry process and post hoc case analysis produced the final surrogate decision model: RČ = .381 (F = 6.43, [F = .05; 9, 94] = 10.65, p < .001). Patient communication (B = .291, srČ = .125) and surrogate self-efficacy (B = .673, srČ = .124), were the two statistically significant variables in the decision-model that accounted for 38.1% of the explained sample variance, and 32.2% (RČadj = .322) of the variance in the surrogate population. The overall study effect size was ES = .38. Remaining model variable contributions included: age, B = .001 (srČ = .010); education, B = -.038 (srČ = .009); gender, B = .-.224 (srČ = .005); ethnicity, B = .400 (srČ = .014); religiosity-spirituality, B = -.002 (srČ = .000), physician communication, B = .028 (srČ = .002), and social support, B = -.004 (srČ = .000). Surrogates were reassured by knowing patients’ verbal and/or written advance treatment instructions. Sustained by knowing “what Mom wanted”, 97.8% of respondents expressed a higher degree of personal decision acceptance by carrying out patient wishes, accepting those decisions as the best alternatives. Following treatment decisions, surrogates expressed high self-reliance and significantly appreciated the benefits associated with treatment decisions. As surrogates must possess essential patient information prior to legitimately exercising legal and moral obligations to the patient in a decision reflecting patient wishes, engagement between social workers and surrogates at hospital/ICU admission can facilitate surrogate-patient communication and information exchange with remaining healthcare professionals. New measurement tools to clarify patient treatment preferences and surrogate role demands enable social workers to prepare surrogates for their role, counter barriers associated with treatment decisions, and mitigate stressors associated with surrogacy.
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