Family Discord and Proxy Decision Makers' End-of-Life Treatment Decisions

Background: Because many Americans are decisionally incapacitated at the end of life, the last treatment decisions are often made by family proxies. Family discord concerning end-of-life (EOL) care may not only exacerbate a family crisis but also influence treatment decisions. We tested the extent to which family discord would be associated with preferences for types of end-of-life care, predicting that greater discord would be associated with weaker preferences for palliative care and stronger preferences for life-prolonging care. Setting/subjects: Sixty-eight proxy decision makers for elderly relatives were interviewed in their homes over the telephone. Measurements: The 35-minute telephone interview assessed preferences for four life-prolonging treatments and for palliative care and included a family discord measure, an EOL values scale, and questions about sociodemographic characteristics. Results: Repeated-measures analyses of covariance and regression analyses showed that greater family discord was associated with stronger preferences for life-prolonging treatments and weaker preferences for palliative care, independently of EOL values and sociodemographic characteristics. Conclusions: In counseling patients with life-limiting illnesses and their families, clinicians should explore possible family discord surroundings EOL care. Counseling protocols should be developed and clinicians should be trained in counseling to minimize family conflict.