Influence of a values discussion on congruence between elderly women and their families on critical health care decisions

This study investigated if prior discussion of values by competent older women (N = 60) with their proxies assisted these proxies to make critical health care decisions in congruence with the desires of the women. Women were randomly assigned to experimental or control groups. Experimental treatment consisted of discussion of value indicators in the presence of their proxies. The proxies were instructed to make decisions in 10 situations across 3 mental states using the substituted judgment standard. The experimental group did not have statistically higher agreement than women-proxy pairs in the control group in 27 of the 30 situations, but they had greater percentage agreement in 11 of the situations. Limitations of the Kappa statistic in health care agreement studies were addressed. The mean treatment decision scores were significantly different across mental states, indicating as mental acuity was decreased in the scenarios, the women were more likely to refuse the recommended treatment.