Preferences of Physicians and Their Patients for End-of-Life Care

Abstract

OBJECTIVE: Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians’ and their patients’ desires for end‐of‐life care for themselves. MEASUREMENTS AND MAIN RESULTS: Study physicians (n= 78) were residents and faculty practicing in an inner‐city, academic primary care general internal medicine practice. Patients (n= 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians’ and patients’ preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7), African‐American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians’ preferences. A treatment preference score was calculated from respondents’ desires to receive or refuse the six treatments. Physicians’ scores were highly correlated with those of their enrolled primary care patients (r= .51, p < .0001). CONCLUSIONS: Although patients and physicians as groups differ substantially in their preferences for end‐of‐life care, there was significant correlation between individual academic physicians’ preferences and those of their primary care patients. Reasons for this correlation are unknown. KEY WORDS: end‐of‐life care; advance directives; patient preferences; physician preferences.

Physicians’ Preferences for Hospice if They Were Terminally Ill and the Timing of Hospice Discussions With Their Patients

“…Evidence suggests that physicians “practice what they preach” when counseling about health behaviors 3 although their treatment recommendations may not necessarily reflect their own preferences, with one study suggesting they recommend more conservative treatments than they might choose for themselves. 4 As physicians may prefer less aggressive end-of-life care than their patients generally receive, 5 physicians’ personal preferences for hospice may influence their approach to hospice discussions with their terminally-ill patients.…”

Increasing use of DNR orders in the elderly worldwide: whose choice is it?

“…81 82 Most physicians would choose not to undergo CPR themselves [81][82][83] and prefer less end-of-life care for themselves than their patients. 84 Two US investigations of university-affiliated physicians in Michigan and Boston suggested that physicians consider age as an important factor in their decision to treat patients aggressively or to use DNR orders, 85 86 although doctors in a British study reported that they did not consider age important in the decision to use CPR. 86 While US physicians told investigators they would be much more likely to resuscitate a middle-aged than an elderly patient, 85 physiological age has been cited as more important than chronological age.…”

“…86 While US physicians told investigators they would be much more likely to resuscitate a middle-aged than an elderly patient, 85 physiological age has been cited as more important than chronological age. 86 Although physicians and patients, when offered hypothetical scenarios of clinical conditions, make similar choices as to whether to write DNR orders, 84 the physicians often misinterpret patients' wishes for CPR 84 87 88 and emphasise the influence of quality of life in reaching a decision more than patients. 89 Doctors who participated in the SUPPORT study predicted 85% of the time that a patient wanted CPR, but less than half the time that a patient did not want CPR.…”

Apoyo con Cariño: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness

“…12,18–22 Furthermore, Latinos are more likely to choose very aggressive care in the face of serious or incurable illness and less likely to acknowledge their terminally ill status. 12,18 Latinos are less likely to have knowledge of advance directives 18,23,24 and are more likely to report that they have not discussed advance care planning with their health care providers. 25 Ethnicity is increasingly recognized as being predictive of poor pain assessment and management.…”