On legal guardianship: An exploratory assessment of knowledge, attitudes and practices of resident physicians

Abstract

Background

Clinicians encounter patients under legal guardianship. We aimed to assess the knowledge, attitudes and practices (KAP) on legal guardianship in residents.

Methods

A KAP pilot survey about legal guardianship was developed by an interdisciplinary medicine-law-public health team and was distributed via institutional email to internal medicine, psychiatry, and neurology residents in a single academic institution.

Results

Of the 172 invited residents, 105 (61%) responded and 102 surveys were included in the final analysis. Most respondents (58% women; internal medicine 73%, neurology 15%, psychiatry 12%) had attended 42 medical schools from 16 countries and had heard about guardianship (88%), but only 23% reported having received training on guardianship during medical school or residency. The vast majority (97%) understood the intended benefit of guardianship, but only 22.5% reported knowing that guardianship removed an individual’s decision-making rights. Nearly half (47%) of respondents reported never having asked for documentation to prove that an individual was a patient’s guardian, and only 15% expected to see a court order as proof of guardianship status.

Conclusions

Although most residents intuitively understood the intended benefit of guardianship, they did not understand its full implications for clinical practice. Training interventions are warranted.

Keywords:

• Guardianship
• medico-legal education
• advocacy
• surrogate decision making

Glossary

Assisted-decision making: Individuals with disabilities aged 18 and over may require help to make decisions. The legal system provides a range of approaches for assisted decision-making that vary in their restrictiveness, from supported decision-making to substitute decision-making (e.g. guardianship).

Guardianship: A type of substitute-decision making in which a court determines an individual incapacitated and unable to make some or all decisions; upon such a finding, the court appoints an individual or organization (i.e. guardian) to make decisions on the individual’s behalf. Also known as conservatorship.

Authors’ statement

All the individuals named as authors meet the journal’s criteria for authorship; everyone who should be listed as an author is listed. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.

Ethical approval

Ethical approval was granted by Rutgers University Arts and Sciences IRB on September 24, 2021, with reference number Pro2021000029. This study has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Prior presentations

Findings related to this project were presented in part at the Society of General Internal Medicine 2022 Conference at Orlando, Florida, on April 6, 2022 (Barajas-Ochoa et al. 2022).

Additional information

Funding

No funding was received to carry out the work described in this article.

Notes on contributors

Aldo Barajas-Ochoa

Aldo Barajas-Ochoa: Infectious Diseases Fellow at Virginia Commonwealth University Health System. Former Internal Medicine Chief Resident at Rutgers New Jersey Medical School.

Thomas I. Mackie

Thomas I. Mackie: Chair of Health Policy and Management and Associate Professor at SUNY Downstate.

Bintu Fofana

Bintu Fofana: MPH student at Rutgers School of Public Health.

Jennifer N. Rosen Valverde

Jennifer N. Rosen Valverde: Distinguished Clinical Professor of Law and Professor Nadine Taub Scholar; Legal Director of H.E.A.L. Collaborative.