Surrogate Decision Making:
Physician Survey
When completing this survey, please think about adult patients you have taken care of while they were in the hospital during the last month. Your participation is voluntary. All responses will be kept confidential. If you do not wish to answer any question, just leave it blank.
Estimated time: 15 minutes
Department of Medicine and The MacLeanCenter for Clinical Medical Ethics
University of Chicago
WeissMemorialHospital
Resurrection Health Care, WestSuburbanHospital
Think about adult inpatients you have cared for in the past month.
1. In the past month, can you think of one or more situations in which you made a clinical decision for a patient who was in the hospital, and the patient could not participate in the decision making process?
(This could be for any reason, for example, due to delirium, sedation, dementia, or psychosis).
1 Yes
2 No Skip to question 29 on page 9
2. How many adult inpatients who could not make their own decisions did you care for in the past month?
1 1 patient
2 2 patients
3 3 patients
4 4 patients
5 More than 4 patients
3. For any of these patients, did you consider whether or not to do any of the following? Mark all that apply.
Yes / NoA) Change code status (Initiate CPR or consider Do Not Resuscitate status) /
1 /
0
B) Initiate or withdraw any life-sustaining therapy (mechanical ventilation, dialysis) /
1 /
0
C) Provide or withhold tube feedings or intravenous nutrition /
1 /
0
D) Withhold or withdraw any other therapy because of the patient’s poor prognosis /
1 /
0
E) Perform major surgery /
1 /
0
F) Transfer the patient to a nursing home or other hospital /
1 /
0
G) Focus on “comfort care” or hospice care /
1 /
0
If you did not consider any of the above items, go to question 29 on page 9.
4. If you checked YES for more than one item for question 3, which was the most recent decision?
Write the letter here:______
Please stop for a moment and think about this patient, the one for whom you made the most recent decision.
Please describe this patient.
5. What was the patient’s sex?
1 Male
2 Female
6. What was the patient’s age?
1 18-302 31-403 41-504 51-605 61-70 6 71-80 7 80+
7. What was the patient’s race?
1 African American/Black2 White (Non-Hispanic)
3 Hispanic/Latino4 Asian
5 Other______
8. How long ago did you last care for this patient?
1 1 week ago2 2 weeks ago3 3 weeks ago
4 4 weeks ago5 more than 4 weeks ago
9. Had you ever provided medical care for this patient before the patient was admitted to the hospital this time?
1 Yes
2 No
DECISION MAKING CAPACITY
10. Which of the following best describes the patient:
1 Definitely lacked the ability to make medical decisions.
2 Probably lacked the ability to made medical decisions.
3 Possibly lacked the ability to make medical decisions.
More questions about the same patient…
THE SURROGATE DECISION MAKER
The term “surrogate decision maker(s)” applies to any family member(s), loved one(s) or a court appointed guardian who made decisions on behalf of the patient.
11. Was there a surrogate decision maker for this patient?
1Yes
2 No
3 Don’t know
More questions about the same patient…
MAKING THE DECISION
15. Did you personally meet or talk by phone with the surrogate decision maker(s) to discuss the decision?
1 Yes
2 No
18. Did you discuss the decision with other physician(s) or other health care worker(s)?
1 Yes
2 No
19. Did another physician or health care worker meet with the surrogate decision maker(s) separately from you to discuss the decision?
1 Yes
2 No
More questions about the same decision…
20. Please rate how much you agree or disagree with the following statements, as they relate to the decision you made for your patient.
Strongly Disagree / Disagree / Neither agree nor disagree / Agree / Strongly AgreeA) Making this decision caused me a great deal of distress. /
1 /
2 / 3 / 4 / 5
B) I felt certain about what was right in this case. /
1 /
2 / 3 / 4 / 5
C) I was satisfied with the outcome of this decision. /
1 /
2 / 3 / 4 / 5
D) I had difficulty contacting the surrogate(s) to discuss this decision. /
1 /
2 / 3 / 4 / 5
E) The surrogate(s) and I agreed about the facts of the patient’s illness /
1 /
2 / 3 / 4 / 5
F) The surrogate(s) and I agreed about the patient’s prognosis. /
1 /
2 / 3 / 4 / 5
G) The surrogate(s) and I agreed about the right thing to do in this case. /
1 /
2 / 3 / 4 / 5
H) There was interpersonal conflict between myself and the surrogate(s). /
1 /
2 / 3 / 4 / 5
I) There was interpersonal conflict between another physician and the surrogate(s). /
1 /
2 / 3 / 4 / 5
J) I was able to effectively communicate with the surrogate decision maker(s). /
1 /
2 / 3 / 4 / 5
K) I provided the surrogate with as much information as possible about the patient’s condition. /
1 /
2 / 3 / 4 / 5
L) I provided guidance to the surrogate about the best choice in this situation. /
1 /
2 / 3 / 4 / 5
21. In the end, the decision was made by:
1 The physician(s) (including yourself)
2 Mostly the physicians
3 Both the surrogate(s) and physician(s)
4 Mostly the surrogate(s)
5 The surrogate(s)
More questions about the same patient…
DECISION MAKING FACTORS
22. There are many issues that that might have been of concern to you as you were making this decision. For each item, please rate how important the issue was in making this decision.
Extremelyimportant / Very
important / Somewhat important / Unimportant or not considered for this decision
A) Your own religious beliefs /
1 /
2 / 3 / 4
B) What the patient would have wanted you to do /
1 /
2 / 3 / 4
C) Concern the surrogate might sue you /
1 /
2 / 3 / 4
D) The patient’s pain and suffering /
1 /
2 / 3 / 4
E) The patient’s prognosis /
1 /
2 / 3 / 4
F) The religious beliefs of the patient /
1 /
2 / 3 / 4
G) The religious beliefs of the family or other surrogate decision maker /
1 /
2 / 3 / 4
H) What was best for the patient, overall /
1 /
2 / 3 / 4
I) The cost to society of caring for this patient /
1 /
2 / 3 / 4
J) Respecting the patient as a person /
1 /
2 / 3 / 4
K) Respecting the wishes of the family/surrogate(s) /
1 /
2 / 3 / 4
L) Following the law /
1 /
2 / 3 / 4
M) The burden on the family /
1 /
2 / 3 / 4
N) Concerns about paying for medical care /
1 /
2 / 3 / 4
23. Of the factors listed above, which was the most important? (Write the letter of the most important item here.)
______
More questions about the same patient…
ADVANCE DIRECTIVES
24. Did the patient have a durable power of attorney for health care (a legal surrogate whom they had previously designated)?
1 Yes
2No
3 Don’t know
25. Did the patient have a living will?
1Yes
2 No
3 Don’t know
27. In the past, had the patient discussed wishes about the kind of care he or she would want in the future with anyone?
1 Yes
2 No
2 Don’t know
You have described a real-life decision making situation. Here are some questions about decision making in general.
STANDARDS FOR DECISION MAKING
29. When a patient lacks decision making capacity, what are the ethical standards physicians should use when they are making medical decisions? Please rank the following from 1 to 5:
____The best interests of the family
____Substituted judgment, or what the patient would have wanted
____Advance directives, if the patient has completed them in the past
____The best interests of society
____The best interests of the patient
30. Please rate how much you agree or disagree with the following statements, as they apply to patients who cannot make their own medical decisions.
It is acceptable to: / Strongly Disagree / Disagree / Neither agree nor disagree / Agree / Strongly AgreeA) Override the surrogate’s wishes for medical treatment if they are not consistent with what the patient would have wanted. /
1 /
2 / 3 / 4 / 5
B) Override the surrogate’s wishes for medical treatment if they are not consistent with what is best for the patient. /
1 /
2 / 3 / 4 / 5
C) Change code status to “Do not resuscitate” if you think it is best for the patient, even if the surrogate objects. /
1 /
2 / 3 / 4 / 5
D) Change code status to “Do not resuscitate” if you think it is what the patient would have wanted, even if the surrogate objects. /
1 /
2 / 3 / 4 / 5
Now, please tell us about yourself.
31. Which of the following best describes you?
1 Intern 2 Resident 3 Fellow4 Attending
32. What year did you graduate from medical school? ______
33. In the past month, about how many patients total did you care for in the inpatient setting?______
34. What is your gender?
1 Female2 Male
35. What is your race?
1 African American/Black2 White (Non-Hispanic)
3 Hispanic/Latino4 Asian
5 Other______
36. What is your religion?
1 Protestant2 Catholic
3 Jewish4 Muslin
5 Other______
37. To what extend do you consider yourself a religious person?
1 Very 2 Moderately 3 Slightly 4 Not at all religious religious religious religious
38. Have you ever been formally taught about surrogate decision making, or how to make decisions for patient who cannot decide for themselves?
1 Yes
2 No
THANK YOU FOR PARTICIPATING.
1
Version May 24, 2006