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Medical Surrogates May Pay Emotional Price for Crisis Decisions
Date:3/1/2011

By Maureen Salamon
HealthDay Reporter

MONDAY, Feb. 28 (HealthDay News) -- The stress of making treatment decisions for a seriously ill loved one inflicts damaging emotional effects on at least one-third of these medical surrogates, a new study suggests.

Researchers examining 40 published articles with data on more than 2,800 surrogates -- more than half of whom were family members of incapacitated patients -- found that the negative psychological impact was often significant and long-lasting.

The medical surrogates were interviewed several months to years after making treatment choices, most of which dictated end-of-life care. Those whose decisions carried out prior directions from the patient fared much better emotionally than those working without advance directives, who suffered guilt and doubt over the decisions they had made.

"One of the strongest predictors of the impact on the family is if they know what the patients want," said lead study author David Wendler, head of the Unit on Vulnerable Populations at the U.S. National Institutes of Health Clinical Center.

"If they know the patient's wishes, they feel as if they just stood up for the patient and they're just channeling the patient's preferences," Wendler said. "If they don't know, they feel stuck, like they're going to have to make this decision for someone else."

The study is published in the March 1 issue of the Annals of Internal Medicine.

Because most of the articles involved U.S. surrogates -- many of them white, educated women -- the authors can't be sure their findings would apply to other groups.

Still, only 20 to 25 percent of adults have completed advance directives or living wills, documents stating the type and aggressiveness of care they would prefer if they become incapacitated by injury or illness and cannot communicate their wishes, Wendler said.

The study analyzed 29 articles using qualitat
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