Stability of Patient Preferences Regarding Life-Sustaining Treatments: RESULTS

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The age of our study participants was 64 ± 9 years. Most patients were white (90 percent), cognitively intact (90 percent by the Short Pbrtable Mental Status questionnaire criteria), and had at least a high school education (59 percent). Other patient characteristics are presented in Table 1.

Percentages of patients favoring each life-sustaining treatment in the three scenarios are shown in Table 2. Most patients desired resuscitation in the current health situation and hospitalization for the treatment of pneumonia in the stroke and dementia scenarios. Fewer patients wanted the other treatments. Larger percentages of patients favored therapies in the cur­rent health situation than in the other scenarios.

Patient acceptance of a specific life-sustaining treat­ment under one scenarios conditions did not ensure acceptance of other types of life-sustaining treatment under the same conditions (Friedman’s chi-square, p<.01). Furthermore, patient preferences for resus­citation and the hospitalized treatment of pneumonia varied significantly across the three scenarios (Fried­mans chi-square for resuscitation, p<0.01; McNemar s chi-square for treatment of pneumonia, p<0.05). canadian pharmacy cialis

Table 1—ICU Patient Characteristics (n=30)

Chronic health problems
Hypertension	47%
Diabetes mellitus	37%
Chronic obstructive pulmonary disease	27%
ICU Admission diagnosis
Possible myocardial infarction	30%
Gastrointestinal bleeding	23%
Cardiac dysrhythmia	20%
ICU Stay, days	3.4± 1.5
ICU Health rating*	3.7± 1.1
ICU Health compared to prior healtht	3.5±0.9
APACHE II Score*	12.3 ±5.2
Current quality of life (self rating)§	3.5± 1.2
Depression index (CES-D)||	16 ±10

The most common reasons for favoring a particular life-sustaining treatment were generally similar under all three scenarios. In the current health scenario, the most common reason for wanting resuscitation was a desire for continuation of interpersonal experiences with family and friends (50 percent). “Chance for cure” was the most frequent explanation for accep­tance of mechanical ventilation (38 percent) and arti­ficial hydration and nutrition (33 percent). In all scenarios, choices to forego life-sustaining treatments were most often attributed to fear of becoming a “caretaking burden.” For example, in the current health scenario, patients reported this reasoning for refusing resuscitation (50 percent) and artificial hydra­tion and nutrition (20 percent). Other major reasons for refusal of a life-sustaining treatment were “natural time” to die; “physical limitations;” and “no chance for cure.”
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Table 2—Percentages of Patients Favoring Life-Sustaining Treatments (n=30)

Treatments	Current Health	Scenarios Stroke Dementia
Resuscitation	87%	53%	37%
Resuscitation and
mechanical ventilation	43%	27%	24%
Artificial hydration and nutrition	50%	40%	28%
Hospitalization for treatment of
pneumonia	N/A	77%	67%

Patient preferences regarding duration of mechani­cal ventilation and artificial hydration and nutrition were similar in all three scenarios. In the current health scenario, many patients favored immediate discontinuation of mechanical ventilation (40 percent) and artificial hydration and nutrition (40 percent). However, patients desiring continuation of these treat­ments indicated a wide range of acceptable durations. For example, patients wanted mechanical ventilation for days (20 percent), weeks (23 percent) and months (7 percent), and artificial hydration and nutrition for days (13 percent), weeks (17 percent), months (13 percent) and years (3 percent). Interestingly, several patients desired indefinite continuation of mechanical ventilation (10 percent) and artificial hydration and nutrition (13 percent).