Research Article
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Published Online: 3 November 2008

Family Discord and Proxy Decision Makers' End-of-Life Treatment Decisions

Publication: Journal of Palliative Medicine
Volume 11, Issue Number 8


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.

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Published In

cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 11Issue Number 8October 2008
Pages: 1109 - 1114
PubMed: 18980451


Published online: 3 November 2008
Published in print: October 2008


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Laraine Winter
Center for Applied Research on Aging and Health (CARAH), Thomas Jefferson University, Philadelphia, Pennsylvania.
Susan Mockus Parks
Family Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.

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