Efficacy Trial of a Digital Intervention Supporting Caregivers as Surrogate Decision Makers

Caregivers often feel unprepared to make surrogate decisions for seriously ill patients. To address this, we developed and trialed a caregiver-facing, interactive website tailored to known surrogate decision-making needs. 42 active caregivers used the website for 7-10 days, with data collected through pre-post surveys, usage analytics, and optional follow-up interviews (n=6). Participants showed significant improvements in engagement in advance care planning (ACP) behaviours across knowledge, contemplation, and readiness domains. Usage patterns suggest that the values elicitation segments were most efficacious. Participants also showed reduction in decisional conflict and improved perceptions towards ACP conversations, although barriers to initiate conversations remained. Interviews highlighted the website's informativeness and support for clinician interactions, while highlighting the need for more personalisation, peer witness, and applicability to real-world decisions. These findings offer early evidence that a caregiver-facing digital intervention can enhance surrogate decision-making preparedness in real-world conditions, with potential for scalability and long-term impact.