Concordance of Patients and Surrogates Regarding Life-Sustaining Therapies in the Context of Surgery: A Scoping Review.

Abstract

The purpose of this study is to establish the scope of literature surrounding the concordance between patients and surrogates when making decisions about life-sustaining therapies in the perioperative setting. This review will lay the foundation for future studies and interventions optimizing perioperative concordance. To understand the performance of surrogates in the context of surgery and the potential for further studies and interventions, we performed a scoping review, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, of MEDLINE (Ovid SP), Embase (Elsevier), Web of Science Core Collection (Clarivate), and the Cumulative Index of Nursing and Allied Health Literature (EBSCO) for studies published before May 5, 2023. A total of 18 records met inclusion criteria. Fifteen were removed because they included the wrong patient population (at least half the study patients were not surgical or article did not discuss patient-surrogate concordance) or were done in the wrong setting (not perioperative) leaving three studies for analysis. There is limited evidence surrounding the concordance of patients and surrogates in the perioperative settings and suggests an unmet need requiring further studies and intervention analysis. Recognition of this gap is important, as it may indicate that an assumption between surrogate and patient concordance may be incorrect, and studies demonstrating how to achieve concordance by piloting educational innovations are necessary.