More patients would refuse treatment if the outcome were impaired quality of life

New Haven, Conn. More patients would refuse life-sustaining treatment if they knew the outcome would be a life of severe functional or cognitive impairment, according to a study by a Yale researcher published Thursday in the New England Journal of Medicine.

"A central component of quality end of life care is honoring patients preferences," said Terri Fried, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine and lead author of the article. "If patients preferences are to be honored, they must be well understood. The results of this study suggest that this understanding depends upon an assessment of patients valuations of treatment burdens in relationship to the likelihood of different potential treatment outcomes. Outcomes of functional and cognitive impairment are particularly important to patients preferences, and require explicit consideration in advance care planning."

Studies examining the outcome of mortality demonstrate that its likelihood also affects preferences, but other outcomes have not been similarly examined. The objective of the current study was to examine the effect of treatment burden, a variety of treatment outcomes, and the likelihood of those outcomes on older seriously ill patients preferences for care.

The study included 226 persons 60 years of age or older with a limited life expectancy because of cancer, congestive heart failure, or chronic obstructive pulmonary disease. The participants were asked if they would want to receive a given treatment, first when the outcome was known with certainty, and then with different likely outcomes. The outcome without treatment was specified as dying of the underlying disease.

When the participants were told they could expect low burden treatment with a return to current health, 98.7 percent chose to receive treatment rather than die without it. When the treatment was changed to high burden, 11.2 percent of the 223 participants who

Contact: Jacqueline Weaver
Yale University

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