Can we begin with the end in mind? End-of-life care preferences before long-term dialysis

摘要

Aligning patients' preferences with the care patients receive at the end of life is a national priority.1 Although some preferences are common among patients and their families, the factors that contribute to high-quality care at the end of life vary considerably across individuals. Values and preferences may be elicited through flexible approaches to shared treatment decision making. Despite greater patient and family satisfaction with high levels of shared decision making,2 end-of-life decisions are often incomplete, especially in acute care settings.3 When end-of-life discussions do occur, patients are more likely to prefer less aggressive care, perhaps because they develop more realistic views about the benefits, or lack thereof, from aggressive therapies near death.