Persons with advanced cancer commonly rely upon family members to assist them with health care choices throughout the course of illness and to make decisions for them when they are unable to self-determine their care. Surrogate decision-making is often a stressful experience with health consequences for the surrogate and ethical consequences for the patient. The purpose of the study is to prospectively and longitudinally investigate decision-making experiences and the social psychological processes that explain how surrogate decision-makers function in their surrogate role for a family member with advanced cancer. The primary aims are to: (1) Explain the basic social process(es) family member surrogate decision-makers use in making end of life care decisions with/for a family member with advanced cancer through the generation of mid-range ? theoretical models., (2) For those patients who move to a palliative or hospice phase of care, explain the process(es) family surrogates use during and subsequent to that decision. The secondary aims are to: (3) Describe surrogates' interactions with the ill family member around health care decisions, (4) Describe surrogates' perceptions of the role and involvement of other family members in decision-making, (5) Describe surrogates' information needs and strategies for obtaining information, (6) Describe how health care professionals influence surrogate decision-making processes, as perceived by the surrogate. The long term objective is to develop theoretically grounded interventions for family surrogate decision-makers. The sample will be surrogate decision-makers for family members with advanced cancer. Study participants will include equal numbers of men and women over the age of 18. Inclusion of ethnically diverse participants will be a priority. Data collection for this prospective, longitudinal study using grounded theory will consist of individual, semi structured interviews conducted at 4-week intervals with approximately 36 participants. All interviews will be audio recorded and transcribed verbatim. Data analysis will follow the constant comparative method of grounded theory. Two verification focus groups will be conducted toward the end of the project. The analytic process will generate theoretical models explaining the process(es) of family surrogate decision-making .which will provide the knowledge needed to design and test interventions to assist surrogate decision-makers. ? ? ?
