0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Patient Preferences for Communication with Physicians about End-of-Life Decisions

Jan C. Hofmann, MD; Neil S. Wenger, MD; Roger B. Davis, ScD; Joan Teno, MD; Alfred F. Connors Jr., MD; Norman Desbiens, MD; Joanne Lynn, MD; and Russell S. Phillips, MD
[+] Article and Author Information

For the SUPPORT Investigators. For author affiliations and current author addresses, see end of text. Grant Support: By the Robert Wood Johnson Foundation. Dr. Hofmann was supported, in part, by National Research Service Award 5T32PE11001. Requests for Reprints: Russell S. Phillips, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, LY-330, 330 Brookline Avenue, Boston, MA 02215. Current Author Addresses: Drs. Hofmann, Davis, and Phillips: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, LY-330, 330 Brookline Avenue, Boston, MA 02215.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(1):1-12. doi:10.7326/0003-4819-127-1-199707010-00001
Text Size: A A A

Background: Physicians are frequently unaware of patient preferences for end-of-life care. Identifying and exploring barriers to patient–physician communication about end-of-life issues may help guide physicians and their patients toward more effective discussions.

Objective: To examine correlates and associated outcomes of patient communication and patient preferences for communication with physicians about cardiopulmonary resuscitation and prolonged mechanical ventilation.

Design: Prospective cohort study.

Setting: Five tertiary care hospitals.

Patients: 1832 (85%) of 2162 eligible patients completed interviews.

Measurements: Surveys of patient characteristics and preferences for end-of-life care; perceptions of prognosis, decision making, and quality of life; and patient preferences for communication with physicians about end-of-life decisions.

Results: Fewer than one fourth (23%) of seriously ill patients had discussed preferences for cardiopulmonary resuscitation with their physicians. Of patients who had not discussed their preferences for resuscitation, 58% were not interested in doing so. Of patients who had not discussed and did not want to discuss their preferences, 25% did not want resuscitation. In multivariable analyses, patient factors independently associated with not wanting to discuss preferences for cardiopulmonary resuscitation included being of an ethnicity other than black (adjusted odds ratio [OR], 1.48 [95% CI, 1.10 to 1.99], not having an advance directive (OR, 1.35 [CI, 1.04 to 1.76]), estimating an excellent prognosis (OR, 1.72 [CI, 1.32 to 2.59]), reporting fair to excellent quality of life (OR, 1.36 [CI, 1.05 to 1.76]), and not desiring active involvement in medical decisions (OR, 1.33 [CI, 1.07 to 1.65]). Factors independently associated with wanting to discuss preferences for resuscitation but not doing so included being black (OR, 1.53 [CI, 1.11 to 2.11]) and being younger (OR, 1.14 per 10-year interval younger [CI, 1.04 to 1.25]).

Conclusions: Among seriously ill hospitalized adults, communication about preferences for cardiopulmonary resuscitation is uncommon. A majority of patients who have not discussed preferences for end-of-life care do not want to do so. For patients who do not want to discuss their preferences, as well as patients with an unmet need for such discussions, failure to discuss preferences for cardiopulmonary resuscitation and mechanical ventilation may result in unwanted interventions.

Figures

Grahic Jump Location
Figure 1.
Flow chart of patients' responses to questions about cardiopulmonary resuscitation (CPR) and prolonged mechanical ventilation.

Shown are the results of patients' responses to three questions on preferences about cardiopulmonary resuscitation and prolonged mechanical ventilation (asked in the order shown, which were part of a larger patient questionnaire about preferences for care administered 2 to 6 days after study enrollment.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)