Institutional members access full text with Ovid®

Share this article on:

Effect of an Educational Video on the Accuracy of Surrogate Decisions: The Case of Electroconvulsive Therapy

Pieroni, Siobhan MRCPsych, MSc; McShane, Rupert MD, MRCPsych

doi: 10.1097/YCT.0b013e3181c18a27
Original Studies

Background: Under the amended Mental Health Act 2007, electroconvulsive therapy (ECT) can only be authorized in an incapacitated patient providing it is not in conflict with the decision of the donee of lasting power of attorney.

Objectives: To assess the ability of surrogates to correctly predict a subject's preference for treatment with ECT both before and after viewing an educational video. The effect of the educational video on attitudes to ECT was also examined.

Methods: Twenty-five subject-surrogate pairs were recruited from relatives of psychiatric patients. The subjects' treatment preferences regarding the ECT and the surrogates' predictions of these preferences were assessed by means of 2 hypothetical scenarios before and after viewing an educational video. An attitude to ECT questionnaire (Questionnaire on Attitudes and Knowledge of ECT) was completed by all participants before and after the video.

Results: Subject-surrogate concordance was high, 84% for scenario 1 (treatment-resistant depression) before and after the video. In scenario 2 (life-threatening depression), concordance rose from 80% before the video to 96% after the video. The greatest increase in concordance occurred in pairs in which neither subject nor surrogate had previous experience of ECT. Attitude scores were significantly more positive after the video.

Conclusions: Surrogates were able to predict the subjects' preference for ECT with high levels of accuracy. This finding is contrary to similar studies involving end-of-life treatment. Providing surrogates with clear, detailed, and accurate information about the proposed treatment may improve surrogate accuracy particularly in treatments such as ECT where widespread misperceptions prevail.

From the Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Oxford, England.

Received for publication May 1, 2009; accepted July 6, 2009.

Reprints: Siobhan Pieroni, MRCPsych, MSc, Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust, Fulbrook Centre, Churchill Hospital, Oxford OX3 7JU, England (e-mail:

This study has no sources of support or funding.

The authors have no conflict of interest to declare.

© 2010 Lippincott Williams & Wilkins, Inc.