Stability of choices about life-sustaining treatments.
OBJECTIVE
To examine the stability of patients' choices for life-sustaining treatments.


METHODS
A longitudinal cohort study.


METHODS
Primary care practices in central North Carolina.


METHODS
Medicare recipients (n = 2536).


METHODS
Participants were asked about demographic characteristics, health status, well-being, depression, social support, use of a living will, and desire for life-sustaining treatment 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.
Danis
M
M
Department of Medicine, University of North Carolina, Chapel Hill 27599-7110.
Garrett
J
J
Harris
R
R
Patrick
D L
DL
D024362:Advance Directive Adherence; D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003863:Depression / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008020:Life Support Care / Q000523:psychology* / Q000706:statistics & numerical data; D016224:Living Wills; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D028761:Withholding Treatment