Jeffrey T. Berger, MD
Potential Conflicts of Interest: None disclosed.
Berger J.; The Effect on Surrogates of Making Treatment Decisions for Others. Ann Intern Med. 2011;155:206. doi: 10.7326/0003-4819-155-3-201108020-00025
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Published: Ann Intern Med. 2011;155(3):206.
TO THE EDITOR:
In their important systematic review, Wendler and Rid (1) highlight an underappreciated phenomenon in clinical care. Surrogates operate under substantial stress, which affects the quality of their decisions as well as the quality of their relationships with their ill relatives and other family members.
Many families whom clinicians label as “difficult” merely have their capacity to cope overwhelmed by these stressors. An important strategy for addressing these challenging families and their decisions that often seem unreasonable is to explicitly recognize and validate the surrogates' emotional burdens. This step alone is often sufficient to mitigate incapacitating loads and is a good step toward enriching the therapeutic relationship and introducing other supports, such as palliative care, pastoral care, and social work.
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