WORDS AND EXPERIENCE MATTER TO SURROGATES MAKING END OF LIFE DECISIONS

Purpose:

The purpose of this study was to investigate the relationship between end of life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults age 50 and older.  

Method(s):

After randomizing participants into two groups; and each received a vignette and personalized it with the name of a loved one. The vignettes varied only in the use of the words “Do Not Resuscitate (DNR)” and “Allow Natural Death (AND)”.  The Decisional Conflict Scale (DCS) was administered and demographic data were collected.

Result(s):

There was no difference in total DCS score based on AND and DNR versions.  Significant findings include the following:                                                                                                                            

1. AND respondents perceived their decision as a good decision, and were eight times more likely to sign the document than DNR participants. This indicated that framing influences surrogate decision making at the end of life.                                                                                                      
2. Experienced decision makers (EDMs) emerged as a discreet group and had lower mean total DCS scores and lower mean subscores. This indicated that prior experience is an important aspect of end of life decision making.                                                                                                                
3. AND and EDM participants were more likely to perceive their decision as good and were more likely to be to be sure of their decision. This indicated that experienced decision makers respond more favorably to the words Allow Natural Death.
                                                                       
4. Respondents to the DNR version were likely to not sign or postpone signing.  
                                         
5. Respondents to the AND version were more likely to make a decision.                                          
6. Participants were more likely to withdraw from the study when the term DNR was used.   
          
7. Participants who reported frequent religious attendance were more satisfied with their decisions.

Conclusion(s):

The results of this preliminary study of primarily Caucasian, fairly well educated, predominantly affluent respondents indicate that the completion of ADs in this demographic population can be influenced by information framing, prior experience with EOL decision-making. Communication modalities, information framing, and decision aids can be critical aspects of EOL communication.  A larger, multi-site study with a more diverse sample would help to verify the results of this study.