Marion Danis, MD; Joanne Garrett, PhD; Russell Harris, MD; Donald L. Patrick, PhD
To examine the stability of patients' choices for life-sustaining treatments.
A longitudinal cohort study.
Primary care practices in central North Carolina.
Medicare recipients (n = 2536).
Participants were asked about demographic characteristics, health status, well-being, depression, social support, use of a living will, and desire for life-sustaining treatments if they were to become terminally ill. These questions were repeated 2 years later (n = 2073, 82% follow-up).
The population tended to choose to forego one more treatment at follow-up than they did at baseline. A choice to forego treatment was twice as stable as a choice to receive treatment. Patients with a living will were less likely to change their wishes (14%) than those without a living will (41%). Persons were more likely to want increased treatment at a later time if they had been hospitalized (23% compared with 18%), had had an accident (29% compared with 19%), had become more immobile (23% compared with 19%), had become more depressed (25% compared with 15%), or had less social support (25% compared with 14%).
Most patients (85%) who had chosen to forego life-sustaining treatments did not change their choices. Nonetheless, these data suggest that it is important to review patients' preferences for life-sustaining treatments rather than to assume the stability of their choices.
Danis M, Garrett J, Harris R, et al. Stability of Choices about Life-Sustaining Treatments. Ann Intern Med. 1994;120:567–573. doi: 10.7326/0003-4819-120-7-199404010-00006
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Published: Ann Intern Med. 1994;120(7):567-573.
End-of-Life Care, Healthcare Delivery and Policy, Hospital Medicine.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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