Predicting changes in preferences for life-sustaining treatment among patients with advanced chronic organ failure.
BACKGROUND
For physicians discussing advance care planning with patients with life-limiting illness, it is important to understand the stability of the patients' preferences for life-sustaining treatments and the factors that predict a change in preferences. Our objectives were to investigate 1-year stability of preferences regarding CPR and mechanical ventilation (MV) for outpatients with advanced COPD, chronic heart failure (CHF), or chronic renal failure (CRF) and to identify predictors of changes in preferences.


METHODS
In this study, 265 clinically stable outpatients with advanced COPD, CHF, or CRF were visited at baseline and every 4 months for 1 year to assess preferences regarding CPR and MV in their current health status. Generalized estimating equations were used to examine the association between change in life-sustaining treatment preferences and several potential predictors, including changes in comorbidities, hospital admissions, generic health status, care dependency, mobility, and symptoms of anxiety or depression.


RESULTS
The 1-year follow-up period was completed by 77.7% of the patients. Preferences regarding CPR or MV changed in 38.3% of the patients during the follow-up period. Changes over time in generic health status, mobility, symptoms of anxiety and depression, and marital status were associated with changes in life-sustaining treatment preferences.


CONCLUSIONS
More than one-third of outpatients with advanced COPD, CHF, or CRF change their preferences regarding CPR and/or MV at least once during 1 year. Regular reevaluation of advance care planning is necessary, in particular when patients experience a change in health status, mobility, symptoms of anxiety or depression, or marital status.


BACKGROUND
Netherlands National Trial Register; No.: NTR 1552; URL: http://www.trialregister.nl.
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands. Electronic address: daisyjanssen@ciro-horn.nl.
Daisy J A
DJA
Janssen
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands.
Martijn A
MA
Spruit
Department of General Practice, Nursing Home Medicine, Faculty of Health Medicine and Life Sciences/CAPHRI, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands.
Jos M G A
JMGA
Schols
Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
Bianca
B
Cox
Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
Tim S
TS
Nawrot
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, Seattle, WA.
J Randall
JR
Curtis
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands.
Emiel F M
EFM
Wouters
D016223:Advance Directives / Q000523:psychology*; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008020:Life Support Care / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D057240:Patient Preference / Q000523:psychology*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology* / Q000628:therapy; D012803:Sick Role; D011795:Surveys and Questionnaires