Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options.

An online sample (N = 172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined person of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers) and choice of end-of-life treatments.

Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments.

The current study's consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making — the initial decision to serve as surrogate, and the surrogate's selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making. For instance, providers can be sensitive to potential cultural differences in surrogate decision-making tendencies or employing decision aids that bolster surrogates’ confidence in their decisions.

Perceived causes of depression can affect treatment preferences and outcomes. Men and women may have somewhat differing views about the causes of their depression, but there is a paucity of research on gender differences in hospitalised patients with depression.

We examined potential gender differences in hospitalised patients’ perceived causes for their depression and their relationship with treatment beliefs and preferences.

A sample of 52 psychiatric inpatients hospitalised with depression was recruited and completed self-report measures of reasons for depression, depression severity, treatment beliefs and preferences.

Biological reasons for depression were associated with more severe depression and more positive medication beliefs. In addition, results showed that women were significantly more likely to endorse physical and biological reasons for their depression compared with men. Gender moderated the relationship between physical reasons for depression and medication beliefs, such that men endorsing physical reasons found antidepressants less acceptable and had more negative beliefs about medication compared to women.

Findings indicate that depressed men and women in the hospital may have differing views about the causes of their depression and this may affect the acceptability of treatments. Depression treatment in inpatient settings should be better personalised to match the beliefs of individual patients.