Choosing life support for suddenly severely ill elderly relatives.

OBJECTIVE: To determine whether relatives are more likely to request intensive treatment for elderly relatives than the elderly parents would wish for themselves, and to explore the reasons which drive this behaviour. METHODS: A potential end-of-life scenario was presented to 30 elderly people and also to their next generation relative who could be required to be a surrogate decision-maker for their elderly relative in the future. A semi-structured interview (which was designed to avoid the use of leading questions) was undertaken by a trained psychology researcher to ascertain the views of the subjects with regard to treatment choices and the motivation underlying these views. RESULTS: Of the potential patients, 83% reported that they would not want intensive treatment in the hypothetical situation. However, while 76% of surrogates also stated that they believed that treatment was inappropriate, all of the surrogates elected to initiate treatment. The need for time to get the family together, the need to reach family consensus and the need to be more certain of prognosis, were major influences which led the surrogates to request initiation of intensive treatment. CONCLUSIONS: Better understanding of the factors which motivate surrogate decision-makers may help the development of measures to avoid the inappropriate use of high technology treatment at the end of life and to achieve outcomes which better match the wishes of the patients whom we treat. Measures which encourage elderly, chronically ill patients to determine their treatment (e.g. by advance directives), rather than delegating the responsibility to relatives, are likely to result in less demand for inappropriate intensive care treatment.

Causal attributions, coping strategies, and adjustment to breast cancer.

In this retrospective questionnaire study of a convenience sample of 244 Australian women, type of causal attributions and their impact on coping strategies adopted by women with breast cancer were studied in relation to women's adjustment to their illness. Although 70% of the women made attributions about their cancer's origins, these women were not significantly better adjusted than women who had not make an attribution. Of those women who had made a causal attribution, type of attribution, whether controllable or uncontrollable (based on perceptions as to the controllability/uncontrollability of the cause of the disease), determined the extent to which exhibited information-seeking behavior. In the present study, women who perceived the cause of their cancer as emanating from uncontrollable circumstances were more active in seeking information about breast cancer than women who perceived the cause of their cancer as emanating from controllable circumstances. Different types of coping strategies adopted by women were associated with adjustment. Women who rated their adjustment as excellent displayed lower levels of helplessness, made fewer changes to their social behavior, were more anxiously preoccupied with their illness, sought more alternatives to medical therapy, and exhibited more information-seeking behavior than did their less-well-adjusted counterparts. The theoretical and practical implications of these results are discussed.