Stability of preferences for end-of-life treatment after 3 years of follow-up: the Johns Hopkins Precursors Study.

摘要

BACKGROUND: Preferences for life-sustaining treatment elicited in one state of health may not reflect preferences in another state of health. METHODS: We estimated the stability of preferences for end-of-life treatment across 3 years and whether declines in physical functioning and mental health were associated with changes in preferences for end-of-life treatment. In this longitudinal cohort study of medical students in the graduating classes of 1948 to 1964 at Johns Hopkins University, 818 physicians completed the life-sustaining treatment questionnaire in 1999 and 2002 (mean age at baseline, 69 years). RESULTS: Although the prevalence of the 3 clusters of life-sustaining treatment preferences remained stable across the 3-year follow-up, certain physicians changed their preferences with time. The probability that physicians were in the same cluster at follow-up as at baseline was 0.41 for "most aggressive," 0.50 for intermediate care, directives were more likely to transition to the most aggressive cluster than to the least aggressive cluster during the 3-year follow-up (odds ratio, 1.96; 95% confidence interval, 1.11-3.45). Age at baseline and decline in physical and mental health were not associated with transitions between 1999 and 2002. CONCLUSION: Periodic reassessment of preferences is most critical for patients who desire aggressive end-of-life care or who do not have advance directives.