Instability of Willingness to Accept Life-Sustaining Treatments in Patients With Advanced Chronic Organ Failure During 1 Year

Carmen H. M. Houben*, Martijn A. Spruit, Jos M. G. A. Schols, Emiel F. M. Wouters, Daisy J. A. Janssen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Web of Science)

Abstract

BACKGROUND: For optimal end-of-life decision-making, it is important to understand the stability of patients' treatment preferences. The aim of this paper is to examine the stability of willingness to accept life-sustaining treatments during 1-year follow-up in Dutch patients with advanced chronic organ failure. In addition, we want to explore the association between willingness to accept high-burden treatment and preferences for CPR and mechanical ventilation (MV).

METHODS: In this multicenter longitudinal study, 265 clinically stable outpatients with advanced COPD (Global Initiative for Chronic Obstructive Lung Disease stage III/IV [n = 105]), chronic heart failure (New York Heart Association class III/IV [n = 80]), or chronic renal failure (requiring dialysis [n = 80) were visited at baseline and at 4, 8, and 12 months to assess the stability of life-sustaining treatment preferences using the Willingness to Accept Life-sustaining Treatment instrument.

RESULTS: Two hundred six patients completed 1-year follow-up (mean age, 67.2 years [SD, 13.1 years]; 64.1% men). Overall, proportions of patients who were willing to accept life-sustaining treatment during 1 year did not change over time. However, individual trajectories showed that about two-thirds of patients changed their preferences at least once during a year. Moreover, there was no association found between the stability of willingness to undergo high-burden therapy and the stability of preferences for CPR and MV.

CONCLUSIONS: The current findings show the complexity of preferences for end-of-life care and indicate once again that advance care planning is a continuous process between patients and physicians, in which preferences for specific situations are discussed and that needs to be regularly reevaluated to deliver high-quality end-of-life care.

Original languageEnglish
Pages (from-to)1081-1087
Number of pages7
JournalChest
Volume151
Issue number5
DOIs
Publication statusPublished - May 2017

Keywords

  • communication
  • end of life
  • life-sustaining treatments
  • palliative care
  • OBSTRUCTIVE PULMONARY-DISEASE
  • CHRONIC HEART-FAILURE
  • TREATMENT PREFERENCES
  • ADVANCED ILLNESS
  • DECISION-MAKING
  • OLDER PERSONS
  • ILL PATIENTS
  • SEVERE COPD
  • CARE
  • ADULTS

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