This cross-sectional descriptive study explored surrogate decision-makers' psychological symptoms and their own assessment of decision-making abilities before actual involvement in end-of-life decision-making for their loved ones. One hundred-twenty dialysis patients' surrogates (79 African Americans and 41 Caucasians) completed scales measuring decision-making confidence, anxiety and depression, Post-Traumatic Symptoms (PTSS), and a sociodemographic questionnaire. Forty-two (35%) and 14 (11.7%) surrogates showed abnormal scores on anxiety and depression, respectively. Seven (5.8%) surrogates showed abnormal scores on PTSS. While surrogates decision making confidence was high (M=17.70, SD=2.88), there was no association between decision-making confidence and the three psychological variables. Surrogates' confidence was associated only with the quality of relationship with patient (r=0.33, p=0.001).