A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions. We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis. 24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors. Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision.

中文翻译：

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老年人寿命终止代理决定的混合方法调查

近亲为失去决策能力的患者制定了许多生命周期决定。这引起了对代理人如何做出这些决定的调查。实验性的观点侧重于研究我们为他人做出的决定与我们自己的决定有何不同，而定性的观点则探索了在做出这些决定时的替代见解。我们进行了混合方法研究，将这两种观点结合在一起。这对于将决策结果与决策过程进行比较至关重要。我们要求年长的成年伴侣互相做出生命终结的决定。然后，他们参加了有关决策过程的半结构化访谈。使用主题分析对成绩单进行分析。24名参与者参加了该研究。代理人比同伴更容易接受挽救生命的治疗，但其伴侣的生活质量却可能下降。这与他们的成绩单相吻合，成绩单表明他们想给伴侣更好的生活机会。尽管有证据表明在决策任务中存在代理错误，但参与者绝大多数报告他们打算做出与替代判断标准一致的决策。但是，由于对自己意愿的不确定性，他们不得不考虑其他因素。采用混合方法可以使我们在决策结果和过程之间进行新颖的比较。我们发现代孕的意图与替代判断标准的期望大体一致，并且先前与伴侣的讨论可以帮助他们做出决定。