Advance Directives, Medical Conditions, and Preferences for End-of-Life Care Among Physicians: 12-year Follow-Up of the Johns Hopkins Precursors Study

Research output: Contribution to journalArticle

Abstract

Context: Stability of preferences for life-sustaining treatment may vary depending on personal characteristics. Objective: We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment. Design: Mailed survey of older physicians. Methods: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model. Results: End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14% of physicians), least aggressive (declining most interventions; 61%), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25%). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment. Conclusion: Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed.

Original languageEnglish (US)
Pages (from-to)556-565
Number of pages10
JournalJournal of Pain and Symptom Management
Volume57
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Advance Directives
Terminal Care
Physicians
Therapeutics
Checklist
Medical Students
Brain Injuries
Longitudinal Studies
Cohort Studies
Cardiovascular Diseases
Anti-Bacterial Agents

Keywords

  • advance directives
  • End-of-life preferences
  • latent transition analysis

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

@article{7afd546528a445298aeb75f73b84b374,
title = "Advance Directives, Medical Conditions, and Preferences for End-of-Life Care Among Physicians: 12-year Follow-Up of the Johns Hopkins Precursors Study",
abstract = "Context: Stability of preferences for life-sustaining treatment may vary depending on personal characteristics. Objective: We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment. Design: Mailed survey of older physicians. Methods: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model. Results: End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14{\%} of physicians), least aggressive (declining most interventions; 61{\%}), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25{\%}). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment. Conclusion: Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed.",
keywords = "advance directives, End-of-life preferences, latent transition analysis",
author = "Gallo, {Joseph J} and Martha Abshire and Seungyoung Hwang and Nolan, {Marie T}",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.jpainsymman.2018.12.328",
language = "English (US)",
volume = "57",
pages = "556--565",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Advance Directives, Medical Conditions, and Preferences for End-of-Life Care Among Physicians

T2 - 12-year Follow-Up of the Johns Hopkins Precursors Study

AU - Gallo, Joseph J

AU - Abshire, Martha

AU - Hwang, Seungyoung

AU - Nolan, Marie T

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Context: Stability of preferences for life-sustaining treatment may vary depending on personal characteristics. Objective: We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment. Design: Mailed survey of older physicians. Methods: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model. Results: End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14% of physicians), least aggressive (declining most interventions; 61%), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25%). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment. Conclusion: Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed.

AB - Context: Stability of preferences for life-sustaining treatment may vary depending on personal characteristics. Objective: We estimated the stability of preferences for end-of-life treatment over 12 years and whether advance directives and medical conditions were associated with change in preferences for end-of-life treatment. Design: Mailed survey of older physicians. Methods: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University. Eight hundred ninety eight physicians who completed the life-sustaining treatment questionnaire anytime in 1999, 2002, 2005, and 2011 (mean age 68.2 years at baseline). Preferences for life-sustaining treatment were assessed using a checklist questionnaire in response to a standard “brain injury” scenario and considered as a package using the latent class transition model. Results: End-of-life preferences grouped into three classes: most aggressive (wanting most interventions; 14% of physicians), least aggressive (declining most interventions; 61%), and an intermediate class (declining most interventions except intravenous fluids and antibiotics; 25%). Physicians without an advance directive were more likely to desire more treatment and were less likely to transition out the most aggressive class. Transition probabilities from class to class did not vary over time. Persons with cancer expressed preference for the least aggressive treatment, whereas persons with cardiovascular disease and depression had preferences for more aggressive treatment. Conclusion: Transitions in end-of-life preferences and the factors influencing change and stability suggest that periodic reassessment for planning end-of-life care is needed.

KW - advance directives

KW - End-of-life preferences

KW - latent transition analysis

UR - http://www.scopus.com/inward/record.url?scp=85061610402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061610402&partnerID=8YFLogxK

U2 - 10.1016/j.jpainsymman.2018.12.328

DO - 10.1016/j.jpainsymman.2018.12.328

M3 - Article

C2 - 30576712

AN - SCOPUS:85061610402

VL - 57

SP - 556

EP - 565

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

IS - 3

ER -