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A Call for a Patient Preference Predictor

OBJECTIVES: When patients lose the capacity to make their own decisions, current practice relies on their family and loved ones to try to identify the treatment course the patient would have chosen for themselves. The fact that this approach has remained essentially unchanged for over 40 years raises the question of whether it successfully provides care that is consistent with patients’ treatment preferences. DATA SOURCES: Published studies on the outcomes and impact of surrogate decision-making. STUDY SELECTION: All identified articles. DATA EXTRACTION: Review by the author. DATA SYNTHESIS: Surrogates frequently are not able to identify the treatment preferences of decisionally incapacitated patients and can experience significant distress as a result of making decisions for them. CONCLUSIONS: Revisions to existing practice are needed to increase the extent to which surrogates are able to identify the treatment preferences of decisionally incapacitated patients. One possibility is to assess whether predicting patients’ treatment preferences based on the preferences of similar patients might increase the extent to which patients are treated consistent with their preferences and thereby reduce the burden on their surrogates.