End-of-life Preferences Can Change

Robert W. Griffith, MD

One tends to assume that the wishes of patients with advanced chronic illness concerning life-sustaining treatment will remain unchanged over time. However, this may not be the case. Researchers at Yale University interviewed almost 200 patients over 60 with advanced cancer, heart failure, or chronic obstructive lung disease (COPD) at intervals, over 3 years (or until death), and reported the findings in the Journal of the American Geriatrics Society.

The interviews assessed the patients' wishes to (1) undergo highly burdensome treatment to avoid death, (2) risk physical disability to avoid death, and (3) risk cognitive disability to avoid death. Responses were classified as "consistent" or "inconsistent". About 50% of patients were inconsistent over time in their willingness to accept physical or cognitive disability to avoid death, and 35% were inconsistent in their willingness to undergo highly burdensome treatment to avoid death. This study shows that a substantial proportion of patients change their minds concerning life-sustaining treatment near the end of life. This is not surprising, as a change in health status can affect a person's sense of what is important. A practical implication, however, is that doctors should repeatedly reassess the preferences of patients with advanced illness, and not remain bound by choices made at a single time point.

These findings shouldn't detract from the importance of everyone having a 'Living Will' as well as other Advance Directives. Five Wishes is a document designed for people to use in stating their preferences for care should they develop any chronic progressive disease. Most importantly, it encourages users to discuss issues that go beyond medical care, such as spiritual needs and family duties during a serious illness. You can obtain a copy here.

Source
HealthandAge Blog

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