Family discord and proxy decision makers' end-of-life treatment decisions

J Palliat Med. 2008 Oct;11(8):1109-14. doi: 10.1089/jpm.2008.0039.


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.

MeSH terms

  • Aged
  • Attitude to Death*
  • Decision Making*
  • Family Relations*
  • Female
  • Humans
  • Interviews as Topic
  • Life Support Care / methods
  • Life Support Care / psychology*
  • Male
  • Middle Aged
  • Palliative Care / methods
  • Palliative Care / psychology*
  • Proxy*
  • Terminal Care / methods
  • Terminal Care / psychology*