Matthew E Modes1, Ruth A Engelberg2, Lois Downey2, Elizabeth L Nielsen2, Robert Y Lee2, J Randall Curtis3, Erin K Kross2. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA. Electronic address: modes@uw.edu. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA. 3. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA; Department of Bioethics and Humanities, University of Washington, Seattle, Washington, USA.
Abstract
CONTEXT: Prioritizing among potentially conflicting end-of-life values may help patients discriminate among treatments and allow clinicians to align treatments with values. OBJECTIVES: To investigate end-of-life values that patients prioritize when facing explicit trade-offs and identify predictors of patients whose values and treatment preferences seem inconsistent. METHODS: Analysis of surveys from a multi-center cluster-randomized trial of patients with serious illness. Respondents prioritized end-of-life values and identified cardiopulmonary resuscitation (CPR) preferences in two health states. RESULTS: Of 535 patients, 60% prioritized relief of discomfort over extending life, 17% prioritized extending life over relief of discomfort, and 23% were unsure. Patients prioritizing extending life were most likely to prefer CPR, with 93% preferring CPR in current health and 67% preferring CPR if dependent on others, compared with 69% and 21%, respectively, for patients prioritizing relief of discomfort, and 78% and 33%, respectively, for patients unsure of their prioritized value (P < 0.001 for all comparisons). Among patients prioritizing relief of discomfort, preference for CPR in current health was less likely among older patients (odds ratio 0.958 per year; 95% CI 0.935, 0.981) and more likely with better self-perceived health (odds ratio 1.402 per level of health; 95% CI 1.090, 1.804). CONCLUSION: Clinicians face challenges as they clarify patient values and align treatments with values. Patients' values predicted CPR preferences, but a substantial proportion of patients expressed CPR preferences that appeared potentially inconsistent with their primary value. Clinicians should question assumptions about relationships between values and CPR preferences. Further research is needed to identify ways to use values to guide treatment decisions.
RCT Entities:
CONTEXT: Prioritizing among potentially conflicting end-of-life values may help patients discriminate among treatments and allow clinicians to align treatments with values. OBJECTIVES: To investigate end-of-life values that patients prioritize when facing explicit trade-offs and identify predictors of patients whose values and treatment preferences seem inconsistent. METHODS: Analysis of surveys from a multi-center cluster-randomized trial of patients with serious illness. Respondents prioritized end-of-life values and identified cardiopulmonary resuscitation (CPR) preferences in two health states. RESULTS: Of 535 patients, 60% prioritized relief of discomfort over extending life, 17% prioritized extending life over relief of discomfort, and 23% were unsure. Patients prioritizing extending life were most likely to prefer CPR, with 93% preferring CPR in current health and 67% preferring CPR if dependent on others, compared with 69% and 21%, respectively, for patients prioritizing relief of discomfort, and 78% and 33%, respectively, for patients unsure of their prioritized value (P < 0.001 for all comparisons). Among patients prioritizing relief of discomfort, preference for CPR in current health was less likely among older patients (odds ratio 0.958 per year; 95% CI 0.935, 0.981) and more likely with better self-perceived health (odds ratio 1.402 per level of health; 95% CI 1.090, 1.804). CONCLUSION: Clinicians face challenges as they clarify patient values and align treatments with values. Patients' values predicted CPR preferences, but a substantial proportion of patients expressed CPR preferences that appeared potentially inconsistent with their primary value. Clinicians should question assumptions about relationships between values and CPR preferences. Further research is needed to identify ways to use values to guide treatment decisions.
Authors: Matthew E Modes; Susan R Heckbert; Ruth A Engelberg; Elizabeth L Nielsen; J Randall Curtis; Erin K Kross Journal: J Pain Symptom Manage Date: 2020-05-07 Impact factor: 3.612
Authors: Matthew E Modes; Ruth A Engelberg; Elizabeth L Nielsen; Lyndia C Brumback; Thanh H Neville; Anne M Walling; J Randall Curtis; Erin K Kross Journal: J Pain Symptom Manage Date: 2022-06-11 Impact factor: 5.576
Authors: Sarah K Andersen; Grace Vincent; Rachel A Butler; Elke H P Brown; Dave Maloney; Sana Khalid; Rae Oanesa; James Yun; Carrie Pidro; Valerie N Davis; Judith Resick; Aaron Richardson; Kimberly Rak; Jackie Barnes; Karl B Bezak; Andrew Thurston; Eva Reitschuler-Cross; Linda A King; Ian Barbash; Ali Al-Khafaji; Emily Brant; Jonathan Bishop; Jennifer McComb; Chung-Chou H Chang; Jennifer Seaman; Jennifer S Temel; Derek C Angus; Robert Arnold; Yael Schenker; Douglas B White Journal: J Pain Symptom Manage Date: 2022-06 Impact factor: 5.576