Stability of Preferences for End-of-Life Treatment After 3 Years of Follow-up

Wittink, Marsha N.; Morales, Knashawn H.; Meoni, Lucy A.; Ford, Daniel E.; Wang, Nae Yuh; Klag, Michael J.; Gallo, Joseph J.

doi:10.1001/archinte.168.19.2125

Cited by 62 publications

(56 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Changes in health status were defined in several ways, including a decline in activities of daily living, decrease in physical functioning measures, and need for hospitalization. Four studies [16][17][18]33 found no relationship between 1 or more ment. Two studies 13,24 found that similar declines in health status were associated with wanting less treatment.…”

Section: Health Status: Objective and Subjectivementioning

confidence: 99%

See 1 more Smart Citation

Stability of End-of-Life Preferences

et al. 2014

View full text Add to dashboard Cite

show abstract

Section: Health Status: Objective and Subjectivementioning

confidence: 99%

“…Six studies 12,[16][17][18]31,32 found no relationship between age and preference stability, while 1 study 4 found increased stability associated with increased age. Sex was assessed as a potential predictor of preference stability in 6 studies.…”

Section: Demographic Factors and Preference Stabilitymentioning

confidence: 99%

Stability of End-of-Life Preferences

et al. 2014

View full text Add to dashboard Cite

show abstract

“…26 In one large study, living wills were completed a median of 20 months before death (mean 43.5 months) with a range of 0-399 months, while health care agents were designated a median of 19 months prior to death (mean 43 months) with a range of 0-1202 months. 4 Patient preferences evolve over time, 24,27 (including among physicians 28 ) and when health status changes. [29][30][31] Patients facing more immediate lifethreatening situations or experiencing more disability tend to tolerate worse functional states and accept more lifesustaining treatments 26,30,32 .…”

Section: Are Advance Care Directives Effective and Safe?mentioning

confidence: 99%

The need for safeguards in advance care planning

Billings

2012

BMJ Support Palliat Care

View full text Add to dashboard Cite

The recent uproar about Medicare "death panels" draws attention to public and professional concerns that advance care planning might restrict access to desired life-sustaining care. The primary goal of advance care planning is to promote the autonomy of a decisionally incapacitated patient when choices about life-sustaining treatments are encountered, but the safety of this procedure has not received deserved scrutiny. Patients often do not understand their decisions or they may change their mind without changing their advance care directives. Likewise, concordance between patients' wishes and the understanding of the physicians and surrogate decision makers who need to represent these wishes is disappointingly poor. A few recent reports show encouraging outcomes from advance care planning, but most studies indicate that the procedure is ineffective in protecting patients from unwanted treatments and may even undermine autonomy by leading to choices that do not reflect patient values, goals, and preferences. Safeguards for advance care planning should be put in place, such as encouraging physicians to err on the side of preserving life when advance care directives are unclear, requiring a trained advisor to review non-emergent patient choices to limit life-sustaining treatment, training of clinicians in conducting such conversations, and structured discussion formats that first address values and goals rather than particular life-sustaining procedures. Key targets for research include: how to improve completion rates for person wanting advance care directives, especially among minorities; more effective and standardized approaches to advance care planning discussions, including how best to present prognostic information to patients; methods for training clinicians and others to assist patients in this process; and systems for assuring that directives are available and up-to-date.

show abstract

“…According to the western bioethics principle, the patient should be central in making this decision [1]. However, not every patient is able to do so, and preferences made in the past might change [2]. Some patients may want their family and the physician to make the decision [3], while physicians may involve the family so as to create a broad basis for the decision making process [4].…”

Section: Introductionmentioning

confidence: 99%