Changes in preferences for life-sustaining treatment among older persons with advanced illness.
BACKGROUND
There are conflicting assumptions regarding how patients' preferences for life-sustaining treatment change over the course of serious illness.


OBJECTIVE
To examine changes in treatment preferences over time.


METHODS
Longitudinal cohort study with 2-year follow-up.


METHODS
Two hundred twenty-six community-dwelling persons age > or =60 years with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease.


METHODS
Participants were asked, if faced with an illness exacerbation that would be fatal if untreated, whether they would: a) undergo high-burden treatment at a given likelihood of death and b) undergo low-burden treatment at a given likelihood of severe disability, versus a return to current health.


RESULTS
There was little change in the overall proportions of participants who would undergo therapy at a given likelihood of death or disability from first to final interview. Diversity within the population regarding the highest likelihood of death or disability at which the individual would undergo therapy remained substantial over time. Despite a small magnitude of change, the odds of participants' willingness to undergo high-burden therapy at a given likelihood of death and to undergo low-burden therapy at a given likelihood of severe cognitive disability decreased significantly over time. Greater functional disability, poorer quality of life, and lower self-rated life expectancy were associated with decreased willingness to undergo therapy.


CONCLUSIONS
Diversity among older persons with advanced illness regarding treatment preferences persists over time. Although the magnitude of change is small, there is a decreased willingness to undergo highly burdensome therapy or to risk severe disability in order to avoid death over time and with declining health status.
Fried
Terri R
TR
Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA. terri.fried@yale.edu
Van Ness
Peter H
PH
Byers
Amy L
AL
Towle
Virginia R
VR
O'Leary
John R
JR
Dubin
Joel A
JA
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008020:Life Support Care / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology