Biomedical subjects

A Fagerlin

Publications and source records attributed to A Fagerlin.

6 recordsLinked to original sources

PubMed2001

Advance directives as acts of communication: a randomized controlled trial.

BACKGROUND: Instructional advance directives are widely advocated as a means of preserving patient self-determination at the end of life based on the assumption that they improve surrogates' understanding of patients' life-sustaining treatment wishes. However, no research has examined whether instructional directives are effective in improving the accuracy of surrogate decisions. PARTICIPANTS AND METHODS: A total of 401 outpatients aged 65 years or older and their self-designated surrogate decision makers (62% spouses, 29% children) were randomized to 1 of 5 experimental conditions. In the control condition, surrogates predicted patients' preferences for 4 life-sustaining medical treatments in 9 illness scenarios without the benefit of a patient-completed advance directive. Accuracy in this condition was compared with that in 4 intervention conditions in which surrogates made predictions after reviewing either a scenario-based or a value-based directive completed by the patient and either discussing or not discussing the contents of the directive with the patient. Perceived benefits of advance directive completion were also measured. RESULTS: None of the interventions produced significant improvements in the accuracy of surrogate substituted judgment in any illness scenario or for any medical treatment. Discussion interventions improved perceived surrogate understanding and comfort for patient-surrogate pairs in which the patient had not completed an advance directive prior to study participation. CONCLUSIONS: Our results challenge current policy and law advocating instructional advance directives as a means of honoring specific patient wishes at the end of life. Future research should explore other methods of improving surrogate decision making and consider the value of other outcomes in evaluating the effectiveness of advance care planning.

Advance Care Planning↗

PubMed2001

Gender differences in older adults' preferences for life-sustaining medical treatments and end-of-life values.

In the present study, we examined gender differences in preferences for life sustaining treatments in response to various health state scenarios and the endorsement of end-of-life values in 99 older adults. Men preferred life-sustaining treatments more than women overall, for specific treatments (i.e., CPR, surgery, and artificial feeding), and in response to specific health scenarios (i.e., current health, Alzheimer's disease, coma with a slight chance of recovery). In terms of values, women indicated a greater desire for a dignified death than men.

Adult↗

PubMed2001

Older adults' attitudes toward death: links to perceptions of health and concerns about end-of-life issues.

The current study had two primary goals, to determine whether: 1) self-rated mental and physical health, pain, and experience with health problems were predictors of elderly adults' attitudes toward death; and 2) death attitudes predict end-of-life medical treatment concerns. Participants were 109 adults, 65 years of age or older (M=78.74 years), recruited from the local community. Regression analysis indicated that poorer perceived physical health predicted a greater likelihood of viewing death as an escape, and poorer perceived mental health predicted a greater fear of death. Viewing death as an escape and fearing death predicted end-of-life medical treatment concerns; a greater endorsement of either attitude predicted more concern. Possible explanations for the links between perceived health, attitudes toward death, and concern about end-of-life issues are suggested.

Aged↗

PubMed2001

Projection in surrogate decisions about life-sustaining medical treatments.

To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed.

Adolescent↗

PubMed1996

Disciplinary Differences in Self-Regulated Learning in College Students

The personal attributes of self-regulated learning are often described in terms of knowledge base, adaptive motivational beliefs, and appropriate use of cognitive and metacognitive strategies for learning. These attributes are usually assumed to apply across all disciplines and contexts, but there has been little research that has examined the disciplinary differences in these personal attributes of self-regulated learning. The present study examined college students' knowledge, motivation, and self-regulatory learning strategies in humanities, social science, and natural science college courses. The sample included 380 college students from three different institutions. Students were given a measure of their course knowledge and a self-report measure of their motivational beliefs and use of self-regulatory strategies at the beginning and end of the semester. Three levels of achievement were created from final course grade and ANOVA's were used to examine the differences in knowledge, motivation, and self-regulation by achievement level and discipline. The results suggest that the components of knowledge, motivation, and self-regulation do distinguish high from low achievers in social and natural science courses, but not in the humanities courses. Results are discussed in terms of the generalizability of our models of self-regulated learning across disciplines and implications for measuring self-regulated learning in different disciplines.

Journal Article↗

PubMedDate not supplied

Modal preferences predict elderly patients' life-sustaining treatment choices as well as patients' chosen surrogates do.

The purpose of this study was to compare the accuracy of an actuarial method of predicting patients' preferences for life-sustaining treatment with the accuracy of surrogate decision makers. 401 outpatients 65 years old or older (mean = 73 years) and their self-designated surrogate decision makers recorded preferences for four life-sustaining medical treatments in nine hypothetical illness scenarios. The surrogates did not predict the patients' preferences more accurately than did an actuarial model using modal preferences. Surrogates' accuracy was not influenced by the use of an advance directive (AD) or discussion of life-sustaining treatment choices. In clinical practice, an actuarial model could assist surrogate decision makers when a patient has no AD, an AD is unavailable, a patient's AD is vague or describes treatment choices for only extreme or unlikely disease states, no proxy decision maker has been designated, or a patient was never competent.

Actuarial Analysis↗