Surrogate Decision Making

许多患者无法自己做出医疗决定（Raymont V, et al . 2004; Silveira MJ, et al . 2010）。目前的临床实践依赖于临床医生和代理人之间的共同决策来为这些患者做出治疗决定。这一决策过程旨在促进符合患者自身偏好和价值观的医疗服务。然而，经验数据表明，这种方法面临两个重大挑战。首先，代理人和临床医生很难预测患者会选择哪种治疗方案。其次，代孕母亲在做出治疗决定后，往往会经历严重的情绪困扰。为了解决这些问题，有人建议，共同决策过程可能会辅以患者偏好预测器（PPP）。购买力平价将根据类似患者在类似情况下的治疗偏好，预测特定患者想要哪种治疗。初步研究表明，将PPP纳入共同决策过程可能有助于提高医疗决策反映决策丧失能力患者偏好的程度，并减轻代理人和临床医生感受到的一些情绪负担。一项对患者的调查发现，如果PPP的使用会提高共享决策过程的预测准确性，那么大多数患者认为将其纳入共享决策过程将是有益的（Rid et al, 2014）。基于这些发现，本研究拟采访参与失能患者决策的代理人，探讨他们对购买力平价的看法以及如何将其纳入医疗决策。

Many patients are unable to make medical decisions for themselves (Raymont V, et al 2004; Silveira MJ, et al 2010). Current clinical practice relies on shared decision-making between clinicians and surrogates to make treatment decisions for these patients. This decision-making process is meant to promote medical care that accords with the patients own preferences and values. However, empirical data suggest that this approach faces two significant challenges. First, surrogates and clinicians have trouble predicting which treatment course patients would have chosen. Second, surrogates often experience significant emotional distress as a result of making treatment decisions. To address these concerns it has been suggested that the shared decision-making process might be supplemented with a Patient Preference Predictor (PPP). A PPP would provide a prediction of which treatment a given patient would want based on the treatment preferences of similar patients in similar circumstances. Preliminary research suggests that incorporating a PPP into the shared decision-making process might help to improve the extent to which medical decisions reflect the preferences of decisionally incapacitated patients and alleviate some of the emotional burden felt by surrogates and clinicians. A survey of patients found that, if the use of the PPP would increase the predictive accuracy of the shared decision-making process, a majority of patients believe that incorporating it into the shared decision-making process would be beneficial (Rid et al, 2014). Based on these findings, the present study proposes to interview surrogates who have been involved in making decisions for an incapacitated patient to explore their perspectives on the PPP and how to incorporate it into medical decision-making.