title: Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation.
abstract: OBJECTIVE
  The objective of this study was to examine whether some treatment preferences are more stable than others, how patient preferences and substituted judgments change over time, and whether some people's decisions are more stable than others'.
  
  
  METHODS
  Hypothetical scenarios elicited preferences for dialysis continuation under various health conditions at two points in time. Predictors included initial treatment preference, age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health.
  
  
  RESULTS
  Some treatment preferences were more stable than others, and the cause of this stability varied across treatment preferences. Similarity between patient preferences and spouse substituted judgments within couples was low and varied as a function of hypothetical condition. The strongest predictor of treatment preferences at follow-up was initial preference. Age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health had limited effects on changes to treatment preferences.
  
  
  CONCLUSIONS
  There is a great deal more stability than change in patient preferences and substituted judgments regarding continuation of dialysis over the course of 1 year. This suggests that if patients have previously expressed preferences it is possible for this to maintain their voice in end-of-life decisions when the patients themselves are unable to express their wishes.
authors.affiliation: New Jersey Institute for Successful Aging, University of Medicine & Dentistry of New Jersey, 42 East Laurel Road, Stratford, NJ 08084, USA. pruchnra@umdnj.edu
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Pruchno
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rovine
authors.forename: Francine
authors.initials: F
authors.lastname: Cartwright
authors.forename: Maureen
authors.initials: M
authors.lastname: Wilson-Genderson
mesh_terms: D000368:Aged; D001294:Attitude to Health; D002755:Choice Behavior; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007600:Judgment; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000706:statistics & numerical data*; D019727:Proxy / Q000706:statistics & numerical data*; D018454:Spouses