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Refusal of medical and surgical interventions common among chronically ill elderly

Chronically ill older persons frequently refuse medical and surgical interventions recommended by their physicians, according to a recent study by Yale School of Medicine researchers. The study suggests that physicians continue to recommend invasive or risky interventions for people with advanced illness despite the patients view that these treatments may be too burdensome, or that the treatment doesnt fit with their goals of care.

Physicians need to offer treatment alternatives that better fit their patients goals and preferences, said first author Marc Rothman, M.D., postdoctoral fellow in geriatrics in the Department of Internal Medicine at Yale.

Published in the July Journal of General Internal Medicine, the study explored the treatment preferences of 226 persons age 60 and older with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease. Trained research assistants conducted in-home interviews with participants at least every four months for up to two years, but more frequently if the patients health status changed (i.e., hospitalizations or initiation of hospice services). Patients were asked whether they had refused or undergone any treatments recommended by their physicians, and why. They were asked to estimate their own longevity, about their desire for prognostic information from physicians, and about their prior experiences with medical decision-making.

Researchers found that 16 percent of these patients reported refusing one or more medical or surgical interventions recommended by their physician. The most frequently refused interventions were cardiac catheterization and surgery, with refusal rates of over 10 percent. Other interventions refused included chemotherapy, radiation, intubation, dialysis, and transplantation. Hospitalization was rarely refused.

The most common reasons given for treatment refusals were fear of side effects. Patients who refused treatments were more
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Contact: Karen N. Peart
karen.peart@yale.edu
203-432-1326
Yale University
8-Aug-2007


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