How do surrogates make treatment decisions for patients with dementia?

To answer this question, a paper by Nicholas et al. (2024) conducted a nationally representative experimental survey. The survey used a series of vignettes related to care decisions of hospitalized adults with dementia. These vignettes were cross-randomized along three dimensions (i) cognitive impairment, (ii) gender, and (iii) characteristics of advance care planning. Based on this approach, the authors had 3 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.

The full article can be found here.