C36-02 Television Depictions of Surrogate Decision Making: A Mixed Methods Content Analysis

Abstract Rationale Surrogate decision making, a process through which someone makes medical decisions on behalf of a patient who lacks capacity, is a cornerstone of patient-centered care and is common in critical illness. Surrogate decision makers face challenging choices for which they are often underprepared, leading to conflict, stress, and care potentially misaligned with patient priorities. Television medical dramas reach broad audiences and influence lay perceptions of healthcare, offering an opportunity to help prepare patients and families for the process of surrogate decision making. Yet, how surrogate decision making is currently portrayed in medical dramas and how well it reflects clinical reality is underexplored. Our objective was to examine portrayal of surrogate decision making in medical dramas and assess whether depictions reflect clinical realities, ethical standards, and best practices. We hypothesized the complexity and nuance of real-world decision making is underrepresented. Methods We conducted a mixed-methods content analysis of 83 episodes from 6 US television series aired between January 2020 and July 2025 (Grey’s Anatomy, Chicago Med, The Pitt, New Amsterdam, The Good Doctor, The Resident). Two coders viewed episodes, abstracted structured data using a guide informed by ethical standards and communication frameworks, and collected in-depth observations using open-ended narrative field notes. We analyzed structured data with descriptive statistics and field notes with inductive, qualitative thematic analysis. Results For 298 patients with at least one major medical decision depicted, 155 (52%) met criteria for requiring a surrogate (i.e., patients lacking capacity). Yet only 58 of the 155 (37%) included a depiction of surrogate involvement in decision making (Figure). When surrogates were depicted, 55 (36%) were patient family members; 4 (2.6%) were identified as legally designated proxies (e.g., legal guardian; health care power of attorney); the surrogate-patient relationship was not stated clearly in 96 (62%) depictions. At least one element of informed consent was depicted in 84 (28%) decisions, and 2 (0.005%) satisfied all informed consent elements. Communication best practices were inconsistently depicted: establishing privacy and providing clinically relevant information were common, while collaborative planning and emotional exploration were uncommon. Qualitative analysis identified ambiguity surrounding patient capacity and decision authority, and surrogate unpreparedness and emotional burden. Conclusions Television medical dramas often omit or simplify the surrogate role, underrepresenting the complexity central to real-world surrogate decision making and potentially shaping unrealistic public expectations. More accurate and nuanced depictions may better prepare patients and families without reducing dramatic impact. This abstract is funded by: None