Patients' preferences concerning medical information and surrogacy: results of a prospective study in a French emergency department

Objective: To study the wishes of a sample of French patients about medical information and surrogacy, at a time when the French Ministry of Health is supporting increased patient autonomy. Design: A cohort of competent patients with non-critical illnesses or injur ies completed an intention-to-act questionnaire on the amount of medical in formation they would want to receive should they be hospitalized or in a li fe-threatening situation. The percentage of patients who would want to have a surrogate if they were in a coma was determined, as well as the identity of the preferred surrogate. The subgroup of patients who were married or l iving with a partner was evaluated separately to determine how often the sp ouse/partner was the preferred surrogate. Associations were looked for betw een patients' wishes and age, sex, educational level, occupation, hierarchi cal order in the family, and level of confidence in medicine. Setting: The emergency room of a teaching hospital in the Paris area (Franc e). Results: Of the 1089 patients included in the study, 5.5 % reported that th ey would not want any information, 25.3 % that they would want to participa te actively in all decisions about their care, and 87.3 % that they would w ant to be fully informed if they were in a life-threatening situation. Slig htly less than one-third of the patients (29.6 %) believed they would not w ant a surrogate if they developed a coma. Among the patients living with a spouse/partner, 40.6 % (229/561) indicated they would want their spouse/par tner to be their surrogate. A significant correlation was observed between wanting more information and wanting a surrogate. Younger patients with a h igher educational level were significantly more likely to predict a desire for information and for a surrogate than the other patients. Conclusion: Our patients expressed a strong desire to receive extensive inf ormation should they become seriously ill, and two-thirds of them reported they would want a surrogate. However, only 40.6 % of the patients living wi th a spouse/partner would want their spouse/partner to be their surrogate. These data suggest that the time has probably come to propose a nation-wide public hearing on medical information and surrogacy in France.