Homeless prefer aggressive medical...( Homeless persons prefer more aggressive...),Health

Homeless persons prefer more aggressive medical care than the physicians making decisions for them, which may result in treatment preferences of homeless persons being overlooked. A new study published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians, reports that homeless persons are more likely than physicians to want lifesaving procedures performed on them. As a result, homeless persons who must rely on physicians as surrogate decision makers for medical care may receive less aggressive treatment than they would choose for themselves.

"Homeless persons are at an increased risk for critical illnesses and admissions to the intensive care unit. They also are less likely to have family or friends to be surrogate decision makers, leaving physicians to make the decisions for them," said study author J. Randall Curtis, MD, MPH, FCCP, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. "Previous research indicates that physicians who make medical decisions independently may make these decisions based on their own preferences. Consequently, homeless individuals are at an increased risk of having life-support decisions made that do not reflect their wishes."

Using a cross-sectional survey, researchers from the University of Washington compared treatment preferences of 229 homeless individuals with preferences of 236 physicians and 111 patients with oxygen-dependent chronic obstructive pulmonary disease (COPD). Participants were asked whether they would want intubation and mechanical ventilation and whether they would want cardiopulmonary resuscitation (CPR) in four health scenarios: current health, permanent coma, dementia unable to recognize family or friends, or bed-bound, dependent on others for care. Compared to physicians, homeless individuals were more likely to want CPR and mechanical ventilation in coma and dementia scenarios.
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Contact: Jennifer Stawarz
jstawarz@chestnet.org
847-498-8306
American College of Chest Physicians
13-Jun-2005

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