Appointment of surrogate decision-makers in the nursing home setting: A nationwide study via the sentinel network of nursing home physicians in France

Aim. - This study aims to measure the proportion of nursing home residents who appointed a surrogate decision-maker, to identify the factors associated with the appointment of such surrogates, and to investigate the associations between the appointment of a surrogate decision-maker and the patterns of end-of-life care in the last month of life of nursing home residents. Methods. - Six hundred and seventy-four nursing home decedents were recruited prospectively between 1 October 2013 and 31 May 2014 via a representative network of 78 nursing home physicians covering 31 different counties in France. Results. - Two hundred and seventy-six nursing home residents (40.9%) appointed a surrogate decision-maker. While controlling for other sociodemographic confounders, the existence of a diagnosed malignancy was associated with an increased likelyhood of appointing a surrogate decision-maker (OR = 1.51; IC95% = 1.01-2.27). In turn, nursing home decedents with an appointed surrogate were more likely to have face-to-face contacts with the coordinating physician and/or their general practionner (OR range = 1.67-1.90), to have their situation assessed during multidisciplinary meetings (OR = 2.03; 95% CI = 1.47-2.81), to be affected by decisions to withhold or withdraw treatments (OR = 1.41; 95% CI = 1.02-1.96) and to be involved in discussions regarding end-of-life care (OR range = 2.04-2.88). Conclusion. - Our study highlights a significant association between the appointment of a surrogate decision-maker and the patterns of end-of-life care in the last month of life of nursing home residents. (C) 2015 Published by Elsevier Masson SAS.