The influence of age on the likelihood of receiving end-of-life care consistent with patient treatment preferences.
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.
Parr
John D
JD
Department of Medical Education, Medical College of Wisconsin, Milwoukee, Wisconsin 53213, USA. jparr@mcw.edu
Zhang
Baohui
B
Nilsson
Matthew E
ME
Wright
Alexi
A
Balboni
Tracy
T
Duthie
Edmund
E
Paulk
Elizabeth
E
Prigerson
Holly G
HG
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