Predicting a Partner's End‐of‐Life Preferences, or Substituting One's Own?

Numerous studies comparing patients' end-of-life health care treatment preferences with their surrogates' reports of those preferences indicate that partners do not know one another 's treatment preferences: Random guesses are just as likely as surrogate choices to match the patients' preferences. The present study uses the empathic accuracy model and the assumed similarity model to shed further light on accuracy and bias in surrogate reports. The data come from the National Center for Family and Marriage Research/Knowledge Networks Pilot Study 2010, a national sample of 1,075 heterosexual American couples age 18 to 64. Surrogate reports were simultaneously biased (i.e., correlated with the surrogate's own preference) and accurate (i.e., correlated with the partner's actual preference). Higher relationship quality and legal marriage (vs. cohabitation) were associated with increased assumed similarity bias. These findings suggest that practitioners working in end-of-life care need to be familiar with their partnered patients' relationship dynamics.Key Words: dyadic/couple data, families in middle and later life, health, multilevel models, relationship satisfaction. U.S. families.Throughout the life course, romantic partners monitor one another's health, providing pressure to adopt healthy behaviors, encouragement to adhere to those behaviors, and instrumental assistance in doing so (Thoits, 2011). Partners continue affecting one another's health even at the end of life, when a partner can be instrumental in determining the health care a dying person receives. In 70% of cases in which a dying older person requires a treatment decision, the person has lost the capacity to make decisions for him- or herself (Silveira, Kim, & Langa, 2010). For 75% of married older adults, the spouse serves as the legal surrogate who is authorized to make medical decisions on behalf of the incapacitated patient (known as a durable power of attorney for health care [DPAF1C]; Carr & Khodyakov, 2007).The law instructs surrogates to apply the standard of substituted judgment, that is, to choose the treatment that the patient him-or herself would choose if able (Sabatino, 2010). Nevertheless, numerous studies that have used hypothetical treatment scenarios to match participants' preferences to their spousal surrogates' reports of those preferences indicate that spouses may often fail at substituted judgment: Random guesses are just as likely as surrogate choices to match participants' preferences (e.g., Moorman & Carr, 2008; Shalowitz, Garrett-Meyer, & Wendler, 2006).Furthermore, although many studies have investigated factors that may influence substituted judgment, few have identified reliable correlates. For instance, men and women are equally poor surrogates, the surrogates of persons in poor health are no more likely to make a substituted judgment than the surrogates of persons in good health, and, most disturbingly, discussions between patient and partner have no effect on substituted judgment (Ditto et ah, 2001; Moorman, Hauser, & Carr, 2009). The strongest known predictor of a surrogate's report is the surrogate's preference for his or her own care (Moorman et ah; Pruchno, Lemay, Feild, & Levinsky, 2005). In addition, African American couples are more likely to be accurate than White couples, and spouses are more likely than adult children to make a correct substituted judgment (Parks et ah, 2011; Schmid, Allen, Haley, & DeCoster, 2010).Although one's partner is integral to one's end-of-life process from initial diagnosis to final goodbye, little research has investigated the role that relationship factors play in determining partners' decision-making processes (Haley et ah, 2002). In the present article we aim to shed further light on the role of relationship quality and marital status in end-of-life decision making through testing hypotheses derived from the empathic accuracy model (Ickes, 1993) and the assumed similarity model (Cronbach, 1955; Kenny & Acitelli, 2001). …