Similar(60)
Investigators concluded that their findings provide an "unequivocal demonstration of the ineffectiveness of patient-surrogate discussion to enhance the accuracy of substitute judgment".
For the majority (70%) of accepted surrogates, the discussion involved only price.
For the majority (61%) of non-accepted surrogates, the discussion considered economic evidence in the form of a model or cost-effectiveness results – suggesting a more complex consideration of a product's value (OR for economic evidence with a non-accepted versus accepted surrogates: 4.1; p = 0.007, Table 3).
Patients were encouraged to include their families, particularly their nominated surrogates, in discussions.
However, among our key informant interviewees, there was support for patients approaching high-risk surgery to initiate ACP focused on identifying patient values and goals, naming a surrogate, and having discussions with surrogates, family and health care providers.
"The tax cut becomes a surrogate for a broader discussion about values and the role of government," a Bush adviser said.
By helping to place patients along this spectrum, the decision aid provided a concrete framework on which a facilitated discussion between surrogate decision makers and clinicians could take place.
We focused on medical reviews of the FDA drug approval process since we found that this is where a discussion of surrogate outcomes would most likely be documented, but there is the possibility that it was mentioned elsewhere in the FDA reviews.
However, some conflicting evidence [ 61, 72, 73] and some methodological [ 11], regulatory [ 74], and conceptual/practical [ 75] arguments fuel the ongoing discussion about surrogate endpoints in the cancer literature [ 76- 78] and challenge the establishment of TDEs in oncology clinical development [ 79].
Substantive discussions of surrogate endpoint validation began in the late 1980s and early 1990s partly driven by the need to find valid biomarkers for Acquired Immunodeficiency Syndrome (AIDS) randomised controlled trials.
Most notably perhaps, and due to the complexity of the patient's condition and treatment regimen, nurse-led critical care research may reach a roadblock without the participation of a clinician to actively participate in the discussions of surrogate consent.
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