However, nine of the 40 articles reported beneficial effects on surrogates, the most common being a feeling of satisfaction from supporting the patient.
"The real problem is that many of these children or spouses have had no preparation as to how to take over this extraordinary role at a time when they themselves are vulnerable," said Dr. Gisele Wolf-Klein, director of geriatric education for the North Shore-LIJ Health System in New Hyde Park, N.Y.
"The stress on the caregiver becomes absolutely phenomenal and often there's major tension between family members," Wolf-Klein added. "These are extraordinarily difficult circumstances."
Ironically, Wendler and Wolf-Klein noted, most patients wish to not become a burden to their loved ones, but that is exactly what happens when people don't discuss or record their medical preferences beforehand.
Also, the turmoil of decision-making can make it difficult for surrogates to comprehend complex information needed to make critical choices, which can involve opting to initiate, withhold, continue or withdraw life-sustaining treatment, according to the study.
Wendler and Wolf-Klein strongly advise creating advance directives to offset the emotional impact on loved ones of carrying out treatment plans.
"All of us should certainly share our wishes . . . we need to have this spelled out very clearly," Wolf-Klein said. "What's terribly important is just to have some form of written documentation of what your wishes are."
Wendler suggested that casual conversations about treatment preferences -- in response to a news story, for example -- can help family members communicate what they want if the unthinkable happens.
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