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 language | English (US) |
|---|---|
| Pages (from-to) | 556-565 |
| Number of pages | 10 |
| Journal | Journal of Pain and Symptom Management |
| Volume | 57 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 1 2019 |
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Keywords
- advance directives
- End-of-life preferences
- latent transition analysis
ASJC Scopus subject areas
- Nursing(all)
- Clinical Neurology
- Anesthesiology and Pain Medicine
Cite this
Advance Directives, Medical Conditions, and Preferences for End-of-Life Care Among Physicians : 12-year Follow-Up of the Johns Hopkins Precursors Study. / Gallo, Joseph J; Abshire, Martha; Hwang, Seungyoung; Nolan, Marie T.
In: Journal of Pain and Symptom Management, Vol. 57, No. 3, 01.03.2019, p. 556-565.Research output: Contribution to journal › Article
}
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 -