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Context: Family members often lack the knowledge of patients' values and preferences needed to function well as surrogate decision-makers.

Objective: To determine whether differences in values and preferences for the advance care planning process may be reasons family members are inadequately informed to act as surrogates.

Design: Face-to-face and telephone surveys using structured questionnaires.

Participants: Two hundred forty-two pairs of dialysis patients and their designated surrogates.

Main Outcome Measures: Content and number of end-of-life care discussions; patient and surrogate attitudes toward having patients express preferences explicitly; factors most important to surrogates in decision making; and within-pair agreement about the values of suffering and certainty.

Results: Ninety percent of patients designated a family member as their surrogate. In most cases, having …