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Medline ® Abstract for Reference 7

of 'Advance care planning and advance directives'

Life-sustaining treatments during terminal illness: who wants what?
Garrett JM, Harris RP, Norburn JK, Patrick DL, Danis M
J Gen Intern Med. 1993 Jul;8(7):361-8.
OBJECTIVE: To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness.
DESIGN: In-person survey from October 1986 to June 1988.
SETTING: 13 internal medicine and family practices in North Carolina.
PATIENTS: 2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses.
MEASUREMENTS AND MAIN RESULTS: The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35% of blacks vs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others).
CONCLUSION: Patients' choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients' preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices.
Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7490.