title: The influence of age on the likelihood of receiving end-of-life care consistent with patient treatment preferences.
abstract: BACKGROUND
  Age differences may help to explain discrepancies in medical care received by cancer patients near death.
  
  
  OBJECTIVE
  Understanding age differences in advanced cancer patients' end-of-life experiences.
  
  
  METHODS
  NCI and NIMH funded multi-site prospective cohort study.
  
  
  METHODS
  396 deceased cancer patients, mean age (58.6 +/- 12.5), in the Coping with Cancer study.
  
  
  METHODS
  Baseline interviews (Treatment Preference) and 1 week postmortem chart reviews (Treatment Received).
  
  
  RESULTS
  14.1% of patients were 20-44 years old, 54.0% were 45-64 years old, and 31.8% were > or = 65 years old. Compared to younger patients, middle-aged patients wanted less life-prolonging care (OR 0.32; CI 0.16-0.64). In the last week of life, older patients were less likely to undergo ventilation (OR 0.27; CI 0.07-1.00) than younger patients. Middle-aged patients who preferred life-prolonging care were less likely to receive it than younger patients (OR 0.21; CI 0.08-0.54), but were more likely to avoid unwanted life-prolonging care (OR 2.38; CI 1.20-4.75) than younger patients. Older patients were less likely to receive desired life-prolonging care than younger patients (OR 0.23; CI 0.08-0.68), however, they were not more likely to avoid unwanted life-prolonging care than younger patients (OR 1.74; CI 0.87-3.47).
  
  
  CONCLUSIONS
  Likelihood of a patient's treatment preference being consistent with care differ by age and treatment preferences. Older patients preferring life-prolonging therapies are less likely to receive them than younger patients; middle-aged patients who want to avoid life-prolonging care are more likely to do so than younger patients. Both findings have implications for patients' quality-of-death, indicating a need for further research.
authors.affiliation: Department of Medical Education, Medical College of Wisconsin, Milwoukee, Wisconsin 53213, USA. jparr@mcw.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Parr
authors.forename: Baohui
authors.initials: B
authors.lastname: Zhang
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nilsson
authors.forename: Alexi
authors.initials: A
authors.lastname: Wright
authors.forename: Tracy
authors.initials: T
authors.lastname: Balboni
authors.forename: Edmund
authors.initials: E
authors.lastname: Duthie
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Paulk
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016013:Likelihood Functions; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms; D057240:Patient Preference; D011446:Prospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult