Not by Linda Carroll
(Reuters Health) – People who are being ignored in making decisions for incapable loved ones tend to believe they know what their loved ones would choose – but the vast majority of those who did Decisions in a recent study are wrong about loved ones.
Researchers who interviewed patients and their separate appointments found that only 21 per cent of patients and senior people were on the same page when it came to find out if specific situations – for example, felt everyday pain, such as Having a broken bone or supplement – is acceptable.
"Patients and their loved ones tend to overstate how well they have talked to each other and how well loved ones understand what the patient would he wants it under the conditions of advanced illness and making decisions about those diseases, "said the study author of the study, Dr. Terri Fried, medicine medicine at Yale Medicine School and a doctor attending VA Connecticut Healthcare System. "The thing that is particularly disturbing in this study is to ask us how confident they were and their level of confidence was high."
The problem is that many assume they have made their wishes clear when they are not, said Fried. "A conversation that does not become natural," he added. "And people often mistakenly pass comments, when they see something on TV, what they would like. So it could have some ER display and the patient could say" Oh yes, I do not want that to happen to me, and the person who transmitted thinks that that meant they had a chat. "
There are results for those who accept those who do not really know what their love wants.
"You have been found in other studies, after having to make such decisions, they often felt very pregnant and then felt they did not know enough about wishes; The patient made an informed decision, "said Fried.
Instead of focusing on specific treatments, such as mechanical ventilation, for example, the researchers focused on outcomes that may or may not want to live with patients.
Those results were: put on the bus and need help with swimming, wearing, pricing and toilet; failure to recognize family members; Daily pain feels like broken bones or availability.
"It's important to note that the whole phone survey probably took about 20 to 25 minutes and interviewers were asking questions about future planning and healthcare decisions," Fried explained. "So if people had questions, the interviewer could explain anything that the respondent did not understand."
As reported in JAMA Internal Medicine, the 349 patients in the randomized study were selected from a list of military veterans living in the community aged 55 and over who were under primary care through VA Connecticut Healthcare System . Initially, patients were asked to give the name of the person they would choose to make medical decisions if they were incapable. More than half of those living in, 52 per cent, were married to patients.
Patient and asset responses agreed individual results between 54 and 59 per cent of the time. But those who got up right for the three results were only 21 percent of the time. However, 75 per cent of people who stood by themselves considered themselves extremely confident that they knew what the patient wishes would be. And among those who were extremely confident, only 23 percent were accurate in their predictions for the three results.
Because people's attitudes can change over time, Fried recommends that people have only one talk about their wishes, but also to return regularly to the subject.
The findings were not surprised. Albert Wu. "Americans are not comfortable thinking of death, especially themselves," said Wu, internist and health policy and management at Johns Hopkins Bloomberg Public Health School. "And I think we're very uncomfortable to have these conversations."
Although it might be difficult to talk about the subject, "it will be much harder to get the talk at an emergency," said Wu, who was not part of the new study. "We do not have enough of these discussions and we do not have enough soon to learn what someone likes it. If we did, many more people would have the kind Of death everyone really wants to: to die in the bed without too much pain that surrounded by your loved ones. "
SOURCE: http://bit.ly/2TLZczV JAMA Internal Medicine, online November 26, 2018.