• Betty S Black, Linda A Fogarty, Hilary Phillips, Thomas Finucane, David J Loreck, Alva Baker, David M Blass, and Peter V Rabins.
• Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer Building, Room 279, Baltimore, MD 21287, USA. bblack@jhmi.edu
• J Aging Health. 2009 Jun 1;21(4):627-50.

ObjectiveThis study examines how surrogate decision makers for dementia patients developed an understanding of patient preferences about end-of-life (EOL) care and patient wishes.MethodsSemistructured interviews were conducted with 34 surrogate decision makers for hospice-eligible nursing home patients with dementia. The data were content analyzed.ResultsMost surrogates reported that patients had previously completed an advance directive (59%), discussed preferences for EOL care (56%), or done both (38%). Catalysts for and barriers to completing an advance directive or having EOL care discussions included factors that were both intrinsic and extrinsic to the patient. The most commonly reported wish for EOL care was to not be kept alive by "machines" or "extraordinary measures."DiscussionHealth care providers may be able to assist patients and families by normalizing discussions of dying, encouraging advance care planning, helping them identify goals for EOL care, and providing information to support treatment decisions consistent with patients' wishes.

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