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 Ͻ .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care ( p Ͻ .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 Ͻ .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.

Predicting Emergency Room Visits and Hospitalizations among Hospice Patients with Cardiac Disease

“…Finally, it was observed that African American patients preferred more aggressive treatment than white patients in the event of terminal illness. 16 It may be inferred from these observations that terminally ill patients who place a greater emphasis on quality of life are more likely to have a DNR order than those who place a greater emphasis on quantity of life. Accordingly, it is also assumed that patient's DNR status itself is a measure of degree to which one prefers aggressive medical interventions.…”

Physician and Nurse Perceptions of a New Inpatient Palliative Care Consultation Project: Implications for Education and Training

“…4 However, national prevalence of inpatient palliative care programs among community provider hospitals is 29%. 5 These programs have been shown to be effective in improving patient outcomes, including satisfaction, pain relief, and care concordance with patient preferences, [5][6][7][8][9][10][11][12] as well as leading to significant reductions in acute care service use. 13 Furthermore, recent studies have documented cost savings associated with the implementation of these consultative teams.…”

Racial variation in the use of do-not-resuscitate orders

“…Though investigation of racial and ethnic variation in the utilization of surgical procedures and in access to primary care has provided important insights into inequities in the current delivery system, [4][5][6][7][8][9][10][11][12] relatively few studies have examined racial variation in the use of DNR orders. Moreover, prior studies largely focused on patient preferences for endof-life care and often involved small sample sizes, [13][14][15] single institutions, 14,16 or highly selected patient populations, 13,15,[17][18][19][20][21][22] raising questions about their generalizability. In addition, some larger studies involved patients hospitalized prior to the Patient Self-Determination Act, 23,24 and thus, may not be representative of current practice.…”