Surrogate decision‐makers from historically marginalized populations have lower levels of preparedness for care planning

Abstract

AbstractBackgroundSurrogate preparedness for medical decision‐making is an important part of care planning. This study examined preparedness and engagement among historically marginalized surrogates.MethodsSurrogates were included if they were named medical decision‐makers by patients ≥55 years at a San Francisco safety‐net and Veterans Affairs hospital. We assessed preparedness for medical decision‐making by asking if surrogates had been formally asked to be the medical decision‐maker, if patients had discussed medical wishes with surrogates, and if the surrogate role and these medical wishes had been documented. We assessed surrogate confidence and readiness using a modified Surrogate ACP Engagement Survey. We used Wilcoxon rank‐sum tests to measure the association of engagement scores with surrogate characteristics.ResultsOf 422 surrogates, their mean age was 53 years (SD ±14.5), 73% were from minoritized groups, 38% were Spanish‐speaking, and 15% had limited health literacy. For preparedness outcomes, 13% of surrogates were not formally asked to play this role, 46% reported the patient had not discussed end‐of‐life medical wishes, and 51% reported there had been no formal documentation of the surrogate role. Surrogates reported higher confidence 4.43/5 (SD ± 0.64) than readiness 3.70 (1.22) for decision‐making (p < 0.001). Confidence and readiness scores were lower among historically marginalized participants.ConclusionMore resources are needed to prepare surrogate decision‐makers from historically marginalized communities for discussing patient's goals of care and treatment preferences.