Do surrogates predict patient preferences more accurately after a physician-led discussion about advance directives? A randomized controlled trial

BACKGROUND: Caregivers frequently assume the role of surrogate decision-makers but often are unable to accurately predict patients’ preferences. This trial aims to find if the use of the Advance Directives documents as a communication tool, improves the agreement between patients and caregivers. METHODS: This trial occurred in a palliative care service of a Portuguese hospital center. A prospective, single-blinded, controlled, randomized trial, enrolling patients and caregivers as a dyad was conducted. Participants individually fulfilled an Advance Directive document, in which patients reported their end-of-life preferences and caregivers reported their decisions as patients’ health surrogates. Dyads were randomly assigned to the Intervention or the Control group, in which the physician respectively promoted an open discussion about patients’ Advance Directives or evaluated patients’ clinical condition. Caregivers’ Advance Directives as surrogates were collected one month later. Proportions of agreement and Cohen’s κ were used to access agreement and reliability, respectively, between the dyads. RESULTS: Results from 58 dyads were analyzed. We observed an improvement in agreement between the caregivers’ answers and the patients’ wishes on two-thirds (8/12) of the answers, in the Intervention group, contrasting to one-quarter (3/12) of the answers, in the Control group, despite statistical significance in differences wasn´t obtained. CONCLUSIONS: Although not reaching statistical significance, the results suggest that discussions of advance directives with physicians may lead to better prepared surrogates. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05090072. Retrospectively registered on 22/10/2021.