Stability of Choices about Life-Sustaining Treatments

doi:10.1059/0003-4819-120-7-199404010-00006

Stability of Choices about Life-Sustaining Treatments

From the University of North Carolina, Chapel Hill, North Carolina, and the University of Washington, Seattle, Washington. Requests for Reprints: Marion Danis, MD, Division of General Medicine, Department of Medicine, CB #7110, 5025A Old Clinic Building, University of North Carolina, Chapel Hill, NC 27599-7110. Grant Support: In part by a cooperative research agreement (95-C-98516/4) between the Health Care Financing Administration and the Department of Social Medicine, School of Medicine at the University of North Carolina at Chapel Hill, in collaboration with the Cecil G. Sheps Center for Health Services Research. The views expressed are those of the authors and do not necessarily reflect the opinions of the Health Care Financing Administration.

Abstract

Objective: To examine the stability of patients' choices for life-sustaining treatments.

Design: A longitudinal cohort study.

Setting: Primary care practices in central North Carolina.

Patients: Medicare recipients (n = 2536).

Intervention: 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).

Results: 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%).

Conclusions: 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.