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Life-sustaining treatments during terminal illness

Who wants what?

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Abstract

Objective: To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness.

Design: In-person survey from October 1986 to June 1988.

Setting: 13 internal medicine and family practices in North Carolina.

Patients: 2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses.

Measurements and main results: The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35%ofblacksvs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others).

Conclusion: Patients’ choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients’ preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices.

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Authors and Affiliations

  1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB# 7590, 725 Airport Road, 3rd Floor, 27599-7490, Chapel Hill, NC

    Joanne Mills Garrett PhD & Jean K. Norburn PhD

  2. the Department of Medicine, University of North Carolina, Chapel Hill, North Carolina

    Russell P. Harris MD, MPH & Marion Danis MD

  3. the Department of Health Services Research, University of Washington, Seattle, Washington

    Donald L. Patrick PhD

Authors
  1. Joanne Mills Garrett PhD
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  2. Russell P. Harris MD, MPH
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  3. Jean K. Norburn PhD
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  4. Donald L. Patrick PhD
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  5. Marion Danis MD
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Additional information

Supported in part by a cooperative research agreement (95-C-98516/4) between the Health Care Financing Administration and the Department of Social Medicine, School of Medicine, in collaboration with the Cecil G. Sheps Center for Health Services Research, at the University of North Carolina at Chapel Hill (Joseph P. Morrissey, PhD, principal investigator).

The views expressed are those of the authors and do not necessarily reflect the opinions of HCFA.

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Garrett, J.M., Harris, R.P., Norburn, J.K. et al. Life-sustaining treatments during terminal illness. J Gen Intern Med 8, 361–368 (1993). https://doi.org/10.1007/BF02600073

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