Date of Graduation

2019

Document Type

Thesis

Degree Type

MS

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Barry Edelstein

Committee Co-Chair

JoNell Strough

Committee Member

Kevin Larkin

Abstract

If a patient becomes unable to adequately express preferences for medical care, another individual called a “surrogate” may be consulted to make treatment decisions. Surrogates may be asked to indicate patient preferences on the Physician Order for Scope of Treatment (POST), a new type of advance directive completed with patients who are estimated to have less than one year left to live. Research from the shared decision-making literature indicates that collaboration can be a valuable means of enhancing patient satisfaction with their decisions. The current study examined how certain psychological and demographic variables predicted the extent to which participants desired collaboration and personal involvement when serving as hypothetical surrogates and making decisions for another person across the three sections of the West Virginia POST form. One-hundred-and-seventy-two adult participants with no prior experience in a formal surrogate decision-making role were recruited from Amazon Mechanical Turk to complete the online survey. Gender predicted collaborative willingness, with women desiring more collaboration than men. A linear multiple regression using the psychological predictor variables of anxiety, intolerance of uncertainty, experiential avoidance, consideration of future consequences, and decision-making confidence contributed significantly to the prediction of collaborative willingness (F(5, 165) = 6.04, p < .001, R 2 = .155). Confidence was the only variable that uniquely contributed to the prediction (β = .30, p < .001), such that greater confidence in one’s decision predicted greater collaborative willingness. The model only significantly predicted collaborative willingness for the decision related to CPR, indicating that differences in the decisions may influence how surrogates approach the three sections of the POST. All of the psychological characteristics except intolerance of uncertainty uniquely contributed to the prediction of scores on the Autonomy Preference Index decision-making preference subscale. Greater decision-making confidence across the three POST decisions predicted lower scores on the API, indicating less preferences for personal involvement. Conversely, greater confidence was associated with higher total collaborative willingness scores, indicating greater preference for collaboration. This discrepancy illuminates how individuals likely approach medical decisions pertaining to their own care (i.e. medical decision situations assessed by the API) differently from those pertaining to someone else (i.e. a surrogate decisionmaking situation).

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