Stability of Patient Preferences Regarding Life-Sustaining Treatments: RESULTS part 2

Posted by James

Fifty-three percent of the ICU patients had previ­ously discussed their preferences about life-prolonging treatments with another person. However, only 10 percent of patients reported communicating their views to a physician. Forty-three percent of married patients had talked with their spouse about their preferences for life-sustaining therapies.

Patients health status and mood generally improved between the two interviews. Eighty percent of patients had returned home. Ten percent were hospitalized on a general medicine service ward and 10 percent were in a nursing home. Patients’ comparative health ratings (comparison of current health to health several months previously) were significantly improved (Wilcoxon 2- tailed, p<0.01). Scores on the CES-D questionnaire showed significant improvement (Wilcoxon 2-tailed p<0.05) with a score of 11 ±10 on the follow-up questionnaire. Despite changes in health status and mood over the month after leaving the ICU, the majority of patients did not change their preferences regarding any of the life-sustaining treatments (Wilcoxon 2-tailed, p>0.05). The changes that did occur were not systematic (Table 3). For example, in the stroke scenario, approximately 10 to 15 percent of patients who had desired a particular life-sustaining treatment while in the ICU expressed their wish to forego this treatment at the follow-цр interview. Similar numbers of patients changed their minds in the opposite direction. Inter¬estingly, the two patients who may have been de-pressed (CES-D score >20) at the ICU interview and not at the follow-up interview did not change their preferences for life-sustaining therapies. Preferences about the duration of mechanical ventilation and artificial hydration and nutrition also did not change significantly over the time period between the two interviews (Wilcoxon two-tailed, p>0.05). The stabil-ity of patients’ preferences for all life-sustaining treat¬ments from the initial to the follow-up interview, despite changes in health and mood, is further re-flected by high kappa statistics (Table 3).
levitra professional

Table 3—Stability of Life-Sustaining Treatment Preferences Between ICU and Follow-up Interviews (n = 20)

	No Change	Percentages of Patients Yes—*No	No—Yes	Statistical Measure Kappa*
Current health
Resuscitation	85%	15%	0%	.47
Resuscitation and mechanical
ventilation	70%	10%	20%	.44
Artificial hydration and nutrition	75%	10%	15%	.59
Stroke
Resuscitation	80%	15%	5%	.58
Resuscitation and mechanical
ventilation	80%	10%	10%	.68
Artificial hydration and nutrition	80%	10%	10%	.70
Hospitalization for treatment of
pneumonia	80%	15%	5%	.36
Dementia
Resuscitation	70%	20%	10%	.46
Resuscitation and mechanical
ventilation	80%	10%	10%	.64
Artificial hydration and nutrition .	85%	5%	10%	.63
Hospitalization for treatment of
pneumonia	65%	25%	10%	.35