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Factors associated with change in resuscitation preference of seriously ill patients. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
Arch Intern Med 1996; 156(14):1558-64AI

Abstract

BACKGROUND

During serious illness, patient preferences regarding life-sustaining treatments play an important role in medical decisions. However, little is known about life-sustaining preference stability in this population or about factors associated with preference change.

METHODS

We evaluated 2-month cardiopulmonary resuscitation (CPR) preference stability in a cohort of 1590 seriously ill hospitalized patients at 5 acute care teaching hospitals. Using multiple logistic regression, we measured the association of patient demographic and health-related factors (quality of life, function, depression, prognosis, and diagnostic group) with change in CPR preference between interviews.

RESULTS

Of 1590 patients analyzed, 73% of patients preferred CPR at baseline interview and 70% chose CPR at follow-up. Preference stability was 80% overall-85% in patients initially preferring CPR and 69% in those initially choosing do not resuscitate (DNR). For patients initially preferring CPR, older age, non-African American race, and greater depression at baseline were independently associated with a change to preferring DNR at follow-up. For patients initially preferring DNR, younger age, male gender, less depression at baseline, improvement in depression between interviews, and an initial admission diagnosis of acute respiratory failure or multiorgan system failure were associated with a change to preferring CPR at follow-up. For patients initially preferring DNR, patients with substantial improvements in depression score between interviews were more than 5 times as likely to change preference to CPR than were patients with substantial worsening in depression score.

CONCLUSIONS

More than two thirds of seriously ill patients prefer CPR for cardiac arrest and 80% had stable preferences over 2 months. Factors associated with preference change suggest that depression may lead patients to refuse life-sustaining care. Providers should evaluate mood state when eliciting patients' preferences for life-sustaining treatments.

Authors+Show Affiliations

UCLA Robert Wood Johnson Clinical Scholars Program, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8687264

Citation

Rosenfeld, K E., et al. "Factors Associated With Change in Resuscitation Preference of Seriously Ill Patients. the SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments." Archives of Internal Medicine, vol. 156, no. 14, 1996, pp. 1558-64.
Rosenfeld KE, Wenger NS, Phillips RS, et al. Factors associated with change in resuscitation preference of seriously ill patients. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Arch Intern Med. 1996;156(14):1558-64.
Rosenfeld, K. E., Wenger, N. S., Phillips, R. S., Connors, A. F., Dawson, N. V., Layde, P., ... Oye, R. K. (1996). Factors associated with change in resuscitation preference of seriously ill patients. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Archives of Internal Medicine, 156(14), pp. 1558-64.
Rosenfeld KE, et al. Factors Associated With Change in Resuscitation Preference of Seriously Ill Patients. the SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Arch Intern Med. 1996 Jul 22;156(14):1558-64. PubMed PMID: 8687264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with change in resuscitation preference of seriously ill patients. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. AU - Rosenfeld,K E, AU - Wenger,N S, AU - Phillips,R S, AU - Connors,A F, AU - Dawson,N V, AU - Layde,P, AU - Califf,R M, AU - Liu,H, AU - Lynn,J, AU - Oye,R K, PY - 1996/7/22/pubmed PY - 1996/7/22/medline PY - 1996/7/22/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Mental Health Therapies KW - Professional Patient Relationship KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - 1558 EP - 64 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 156 IS - 14 N2 - BACKGROUND: During serious illness, patient preferences regarding life-sustaining treatments play an important role in medical decisions. However, little is known about life-sustaining preference stability in this population or about factors associated with preference change. METHODS: We evaluated 2-month cardiopulmonary resuscitation (CPR) preference stability in a cohort of 1590 seriously ill hospitalized patients at 5 acute care teaching hospitals. Using multiple logistic regression, we measured the association of patient demographic and health-related factors (quality of life, function, depression, prognosis, and diagnostic group) with change in CPR preference between interviews. RESULTS: Of 1590 patients analyzed, 73% of patients preferred CPR at baseline interview and 70% chose CPR at follow-up. Preference stability was 80% overall-85% in patients initially preferring CPR and 69% in those initially choosing do not resuscitate (DNR). For patients initially preferring CPR, older age, non-African American race, and greater depression at baseline were independently associated with a change to preferring DNR at follow-up. For patients initially preferring DNR, younger age, male gender, less depression at baseline, improvement in depression between interviews, and an initial admission diagnosis of acute respiratory failure or multiorgan system failure were associated with a change to preferring CPR at follow-up. For patients initially preferring DNR, patients with substantial improvements in depression score between interviews were more than 5 times as likely to change preference to CPR than were patients with substantial worsening in depression score. CONCLUSIONS: More than two thirds of seriously ill patients prefer CPR for cardiac arrest and 80% had stable preferences over 2 months. Factors associated with preference change suggest that depression may lead patients to refuse life-sustaining care. Providers should evaluate mood state when eliciting patients' preferences for life-sustaining treatments. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/8687264/Factors_associated_with_change_in_resuscitation_preference_of_seriously_ill_patients__The_SUPPORT_Investigators__Study_to_Understand_Prognoses_and_Preferences_for_Outcomes_and_Risks_of_Treatments_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/156/pg/1558 DB - PRIME DP - Unbound Medicine ER -