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

Lauren Nicholas, Kenneth M. Langa, Scott D. Halpern and Mario Macis

No 32116, NBER Working Papers from National Bureau of Economic Research, Inc

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.

JEL-codes: C99 I12 J14 (search for similar items in EconPapers)
Date: 2024-02
New Economics Papers: this item is included in nep-age, nep-exp, nep-hea and nep-neu
Note: AG EH
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Published as 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," Health Economics, vol 33(6), pages 1211-1228.

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