TY - JOUR
T1 - Preferences on forgoing end-of-life treatment are stable over time with people owning an advance directive; A cohort study
AU - van Wijmen, Matthijs P.S.
AU - Pasman, H. Roeline W.
AU - van de Ven, Peter M.
AU - Widdershoven, Guy A.M.
AU - Onwuteaka-Philipsen, Bregje D.
PY - 2020
Y1 - 2020
N2 - Objective: We studied if preferences about end-of-life care of people having an advance directive (AD) stay stable over time and if (in) stability is associated with health status. Methods: A longitudinal cohort study with a population owning different types of ADs (n = 4638). Respondents repeatedly answered questionnaires between 2005−2010. Using hypothetical scenarios about advanced cancer and dementia we assessed preferences for continuing or forgoing resuscitation, mechanical ventilation, artificial nutrition and antibiotics. Using generalized estimated equations we analysed whether life-events and quality of life influenced changes in preferences. Results: The proportion of respondents with stable preferences ranged from 67 to 98 %. Preferences were most stable concerning resuscitation and least stable concerning mechanical ventilation. In only a few instances we found life-events or a change in quality of life could both increase or decrease odds to change preferences. Conclusion: Preferences concerning continuing or forgoing treatment at the end of life are stable for a majority of people with ADs, which supports their validity. Practice implications: The value of on-going communication about preferences between patients and caregivers is confirmed by our findings concerning differences in stability between treatments and the association between stability of preferences and life-events or quality of life.
AB - Objective: We studied if preferences about end-of-life care of people having an advance directive (AD) stay stable over time and if (in) stability is associated with health status. Methods: A longitudinal cohort study with a population owning different types of ADs (n = 4638). Respondents repeatedly answered questionnaires between 2005−2010. Using hypothetical scenarios about advanced cancer and dementia we assessed preferences for continuing or forgoing resuscitation, mechanical ventilation, artificial nutrition and antibiotics. Using generalized estimated equations we analysed whether life-events and quality of life influenced changes in preferences. Results: The proportion of respondents with stable preferences ranged from 67 to 98 %. Preferences were most stable concerning resuscitation and least stable concerning mechanical ventilation. In only a few instances we found life-events or a change in quality of life could both increase or decrease odds to change preferences. Conclusion: Preferences concerning continuing or forgoing treatment at the end of life are stable for a majority of people with ADs, which supports their validity. Practice implications: The value of on-going communication about preferences between patients and caregivers is confirmed by our findings concerning differences in stability between treatments and the association between stability of preferences and life-events or quality of life.
KW - Advance directives
KW - End-of-life care
KW - End-of-life decisions
KW - Patient preferences
UR - http://www.scopus.com/inward/record.url?scp=85086158667&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.pec.2020.05.031
DO - https://doi.org/10.1016/j.pec.2020.05.031
M3 - Article
C2 - 32532634
SN - 0738-3991
JO - Patient Education and Counseling
JF - Patient Education and Counseling
ER -