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How Do Surrogates Make Treatment Decisions for Patients with Dementia? An Experimental Survey Study

Author

Listed:
  • Lauren Hersch Nicholas
  • Kenneth M. Langa
  • Scott D. Halpern
  • Mario Macis
Abstract
Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making. We conducted a nationally representative experimental survey that cross-randomized cognitive impairment, gender, and characteristics of advance care planning among hospitalized older adults through a series of vignettes. Our study yielded three main findings: first, respondents were much less likely to recommend life-sustaining treatments for patients with dementia, especially after personal exposure. Second, respondents were more likely to ignore patient preferences for life-extending treatment when the patient had dementia, and choose unwanted life-extending treatments for patients without dementia. Third, in scenarios where the patient's wishes were unclear, respondents were more likely to choose treatments that matched their own preferences. These findings underscore the need for improved communication and decision-making processes for patients with cognitive impairment and highlight the importance of choosing a surrogate decision-maker with similar treatment preferences.

Suggested Citation

  • Lauren Hersch Nicholas & Kenneth M. Langa & Scott D. Halpern & Mario Macis, 2024. "How Do Surrogates Make Treatment Decisions for Patients with Dementia? An Experimental Survey Study," NBER Working Papers 32116, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:32116
    Note: AG EH
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    References listed on IDEAS

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    More about this item

    JEL classification:

    • C99 - Mathematical and Quantitative Methods - - Design of Experiments - - - Other
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • J14 - Labor and Demographic Economics - - Demographic Economics - - - Economics of the Elderly; Economics of the Handicapped; Non-Labor Market Discrimination

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