Effects of Repeated Decision Making Among Surrogates of Seriously Ill Patients
| Status: | Completed |
|---|---|
| Conditions: | Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/7/2015 |
| Start Date: | November 2012 |
| End Date: | November 2013 |
| Contact: | Mary McKenzie, MD |
| Email: | mary.mckenzie@uphs.upenn.edu |
| Phone: | 215.573.9461 |
Pilot Study of Repeated Decision Making in Surrogates
Decision making capacity fatigues after repeated decisions similar to skeletal muscle. The
result is decision fatigue, in which subsequent decisions are altered toward the status quo.
Surrogates are at risk for decision fatigue yet it has not been studied. We propose a
randomized study in the outpatient setting in surrogates and patients at high risk for
needing to make complex decisions, in an effort to determine the impact of decision fatigue
on surrogate self-control and subsequent choices.
result is decision fatigue, in which subsequent decisions are altered toward the status quo.
Surrogates are at risk for decision fatigue yet it has not been studied. We propose a
randomized study in the outpatient setting in surrogates and patients at high risk for
needing to make complex decisions, in an effort to determine the impact of decision fatigue
on surrogate self-control and subsequent choices.
Just as skeletal muscle fatigues after repeated use, decision-making capacity fatigues when
repeated choices are made. This phenomenon, in which people experience diminished
concentration and willpower after repeated decision-making, is termed decision fatigue.
People experiencing decision fatigue are more likely to bias subsequent choices toward the
status quo. By choosing the status quo, the decision-maker reserves the option to make an
alternate choice at a later time, thereby preserving possibilities. Patients and their
surrogates often make complex medical decisions for which they may have little experience.
Although clearly at high risk, decision fatigue has not been studied in this population. To
elucidate these questions, we propose a four-arm study of surrogates and patients in a
population at high risk for making complex decisions. Surrogates will be randomly assigned
to varied levels of decision making effort to assess for the development of resultant
decision fatigue and whether it alters subsequent decisions.
repeated choices are made. This phenomenon, in which people experience diminished
concentration and willpower after repeated decision-making, is termed decision fatigue.
People experiencing decision fatigue are more likely to bias subsequent choices toward the
status quo. By choosing the status quo, the decision-maker reserves the option to make an
alternate choice at a later time, thereby preserving possibilities. Patients and their
surrogates often make complex medical decisions for which they may have little experience.
Although clearly at high risk, decision fatigue has not been studied in this population. To
elucidate these questions, we propose a four-arm study of surrogates and patients in a
population at high risk for making complex decisions. Surrogates will be randomly assigned
to varied levels of decision making effort to assess for the development of resultant
decision fatigue and whether it alters subsequent decisions.
Inclusion Criteria:
- Patients must have one of the following diagnoses: aplastic anemia, multiple myeloma,
myelodysplastic syndrome, acute myeloid leukemia, stage IIIB or IV lung cancer,
mesothelioma and/or stage IIIB or IV gastrointestinal cancer (pancreatic, biliary,
esophageal, gastric, hepatocellular, colon), stage IV melanoma.
- Patients must have at least one surrogate at their clinic visit who is willing to
enroll with them as a pair to be included.
- Surrogates are eligible if an eligible patient identifies them as as a surrogate and
both consent for the study.
- All participants must be over the age 18
- All participants must be fluent in English
Exclusion Criteria:
- Patients and surrogates will be excluded if they are illiterate or have a medical
condition known to alter Stroop performance. These include individuals who are
visually impaired such that they cannot read a computer screen, blind or colorblind,
patients given sedating medications during their appointment and individuals with
past medical history of cerebrovascular accident, transient ischemic attack (TIA),
seizure disorder, dementia or traumatic head injury with loss of consciousness.
- Patients will be ineligible if they have either tracheostomy or are currently on
hemodialysis as these would significantly alter responses to the mechanical
ventilation hypothetical scenario and the hypothetical life sustaining therapy
question.
- Surrogates and patients are ineligible if their paired participant is excluded for
any of the above reasons.
We found this trial at
1
site
Philadelphia, Pennsylvania 19104
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