Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment.
OBJECTIVE
To determine whether preferences for future attempts at life-sustaining treatment change over time in a consistent and predictable manner.


METHODS
Observational cohort study.


METHODS
Community.


METHODS
One hundred eighty-nine community-dwelling persons ages 60 and older with advanced cancer, 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 undergo high-burden therapy for a chance to avoid death and risk an impaired health state to avoid death. Interviews occurred at least every 4 months for up to 2 years.


RESULTS
When asked their willingness to undergo high-burden therapy for a chance to avoid death, 35% had an inconsistent preference trajectory (e.g., becoming more and then less willing over time or vice versa). The proportion with inconsistent trajectories increased to 48% and 49% when asked their willingness to risk physical or cognitive disability, respectively, to avoid death. Participants with variable health states over time were more likely to have inconsistent trajectories, although inconsistent trajectories were also common in those with stable health states.


CONCLUSIONS
A large proportion of older persons with advanced illness have inconsistent trajectories of willingness to undergo burdensome therapy or risk an impaired health state for a chance to avoid death. Variability in their health state over time explained this in part, although the frequency of inconsistent trajectories even in those with stable health states suggests that preferences are influenced by transient factors rather than representing stable core values.
Fried
Terri R
TR
Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA. terri.fried@yale.edu
O'Leary
John
J
Van Ness
Peter
P
Fraenkel
Liana
L
D000368:Aged; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D010349:Patient Compliance; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires