Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population

Schonwetter, Ronald S.; Walker, R. M.; Solomon, Marcy; Indurkhya, Alka; Robinson, Bruce E.

doi:10.1111/j.1532-5415.1996.tb01867.x

Cited by 41 publications

(32 citation statements)

References 16 publications

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“…These values include preferences for autonomous versus shared decision making (Blackhall et al, 1995), concern for individual versus family or community interests (Klessig, 1992), beliefs in sanctity of life or possibility of miracles (Klessig, 1992), and personal ideas about what makes life worth living versus intolerable (Ditto, Druley, Moore, Danks, & Smucker, 1996). Although there is evidence that values-related variables do correspond to decision outcomes (Fischer, Alpert, Stoeckle, & Emanuel, 1997;Schonwetter, Walker, Solomon, Indurkhya, & Robinson, 1996), there is mixed evidence regarding the stability of and relationship between values and treatment preferences through time (Ditto et al, 2003;Emanuel, Emanuel, Stoeckle, Hummel, & Barry, 1994;Lockhart, Ditto, Danks, Coppola, & Smucker, 2001). …”

Section: Va Author Manuscriptmentioning

confidence: 99%

“…Each item was rated on a 3-point scale, where 1 = influence not at all, 2 = influence a little, and 3 = influence a lot. Prior research found evidence of individual variability when asking people to rate the importance of various factors that might influence medical decisions or end-of-life care, as well as evidence of underlying constructs that such items tap (Doukas & Gorenflo, 1993;Karel, 2000;Karel & Gatz, 1996;Schonwetter et al, 1996;Steinhauser et al, 2000).…”

Section: Participantsmentioning

confidence: 99%

“…Each item was rated on a 3-point scale, where 1 = influence not at all, 2 = influence a little, and 3 = influence a lot. Prior research found evidence of individual (Doukas & Gorenflo, 1993;Karel, 2000;Karel & Gatz, 1996;Schonwetter et al, 1996;Steinhauser et al, 2000).Trusted and nontrusted surrogate decision makers: After completing the interview-based forced-choice Health Care Values Survey items, participants were asked to name individuals they would or would not want to make decisions for them if they were not able to speak for themselves. The questions were as follows:…”

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confidence: 99%

“…Some of these "values history" tools are designed as open-ended questions or interviews (Gibson, 1990;Hammes & Rooney, 1998;Karel et al, 2004;Schwartz et al, 2003), whereas others include specific rating scales or questions about treatment preferences (Doukas & McCullough, 1991;Gillick, Berkman, & Cullen, 1999;Pearlman, Starks, Cain, Rosengreen, & Patrick, 1998). Some instruments were designed primarily for research purposes (Ditto et al, 1996;Karel & Gatz, 1996;Lawton et al, 1999;Schonwetter et al, 1996).…”

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confidence: 99%

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Three Methods of Assessing Values for Advance Care Planning

Karel¹,

et al. 2007

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Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools-open-ended, forced-choice, and rating scale questions-and named a preferred surrogate decision maker. Responses to forced-choice items were examined at 9-month retest. Adults with and without dementia appeared equally able to respond meaningfully to questions about values regarding quality of life and health care decisions. People with dementia were generally as able as controls to respond consistently after 9 months. Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able. Keywords advance care planning; values; dementiaOlder adults at risk for dementia or with early dementia may be particularly interested to engage in advance care planning. Broadly speaking, advance care planning entails communicating with loved ones, health care providers, or other relevant parties to prepare for decisions that may need to be made during a time of future decisional incapacity. For older adults at risk for dementia, such planning might entail preparing for financial, residential, and/or health care eventualities. Within the health care realm, advance care planning has primarily focused on the completion of advance directives that allow individuals to designate surrogate decision makers (i.e., durable power of attorney for health care) or to document particular health care instructions (i.e., living will). However, research and clinical evidence suggests that completing advance directives-in the absence of communication about an individual's and his or her family's values, fears, and preferences -may not ultimately help to facilitate good decisions on behalf of individuals with dementia or other incapacitating illnesses (Covinsky et al., 2000;Miles, Koepp, & Weber, 1996;Teno et al., 1997).Please address correspondence to Michele J. Karel, PhD, Psychology Service 3-5-C, Brockton VA Medical Center, 940 Belmont Street, Brockton, MA 02301; Michele.Karel@va.gov.. Authors' Note: Adam Bank is now in independent practice in Weston, Florida. Armin Azar is now at the Department of Psychological and Brain Sciences, University of Louisville, Kentucky. U.S. Department of Veterans AffairsPublic Access Author manuscript J Aging Health. Author manuscript; available in PMC 2016 May 06. VA Author Manuscript VA Author Manuscript VA Author ManuscriptA process of values clarification in advance care planning recognizes both that individuals differ in health-care related beliefs and preferences and that medical decisions are made within a social context. With regard to individual differences, cultural (Blackhall, Murphy, Frank, Michel, & Aze...

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Section: Va Author Manuscriptmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Three Methods of Assessing Values for Advance Care Planning

Karel¹,

et al. 2007

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“…In addition, studies have suggested an overall need for enhanced public knowledge about end-of-life care (Marcoux et al 2007;Taylor et al 2003;Marco and Larkin 2003). Many patients welcome the opportunity to discuss their wishes (Stolman et al 1990;Hakim et al 1996;Gunasekera et al 1986;Schonwetter et al 1996;Uhlmann and Pearlman 1991).…”

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confidence: 94%

End-of-Life Terminology: The ED Patients’ Perspective

Marco

Savory

Treuhaft

2010

AJOB Primary Research

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What Do Patients Express as Their Preferences in Advance Directives?

Gross¹

1998

Arch Intern Med

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The overwhelming desire expressed by the patients in the ADs was not to have their lives prolonged if their medical condition were such that treatment would merely delay death. Only a minuscule number of patients, less than 0.7%, wanted everything done to prolong life regardless of the chance for improvement or the cost. Because such a small percentage of patients have ADs, it is recommended that each hospital appoint a committee on ADs to do everything possible to encourage patients to execute an AD. A second mission of this committee would be to do everything possible to encourage physicians to pay close attention to their patients' wishes for medical care at the end of life.

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Life Values, Resuscitation Preferences, and the Applicability of Living Wills in an Older Population

Abstract: Subjects misinterpreted the applicability of living wills in nonterminal illness scenarios. A relationship between life values and resuscitation preferences was noted, which emphasizes the importance of eliciting and including life values when discussing advance directives.

Cited by 41 publications

References 16 publications

Three Methods of Assessing Values for Advance Care Planning

Three Methods of Assessing Values for Advance Care Planning

End-of-Life Terminology: The ED Patients’ Perspective

What Do Patients Express as Their Preferences in Advance Directives?

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