BACKGROUND: Physician-initiated advance care planning is desirable, effective, and routinely indicated for competent adult patients,
but doctors are often reluctant to begin the necessary conversations.
OBJECTIVE: To determine whether patients are willing and able to designate a surrogate for medical decision making, when asked to do
so as part of routine medical inquiry.
DESIGN, PATIENTS, MEASUREMENTS: A survey asking patients to name a health care agent was designed and administered in the context of routine clinical care.
Participants were drawn from a consecutive sample of 309 competent adult outpatients. Data were analyzed using ordinary descriptive
statistics.
RESULTS: Two hundred ninety-eight of 309 patients (response rate, 96%) completed the survey and were willing and able to specify a
proxy for health care. One third of married participants did not choose their spouse as proxy.
CONCLUSIONS: Asking patients to identify a surrogate for medical decision making opens the door for ongoing individualized medical care
planning in the context of ordinary patient-physician interaction. This approach is applicable to all competent adults. Documenting
proxy choice protects a patient’s wishes and preferences until more definitive planning is accomplished.
Key Words proxy - advance care planning - advance directives - decision making - physician-patient relations
The author has no funding sources and no conflicts of interest to report.
A paper based on this investigation was presented as:
Jump Starting Advance Care Planning in the Context of Standard Medical Treatment: A Return to Basics
K. Michael Lipkin, MD; Nina Lipkin, MA