 |
|
The Value of Disease Severity in Predicting Patient Readiness to Address End-of-Life Issues
Mark P. Pfeifer, MD;
Charlene K. Mitchell, MD;
Lynell Chamberlain, MD
Arch Intern Med. 2003;163:609-612.
Background Although patient-physician discussion is the most important tool for end-of-life planning, less than 30% of seriously ill patients have held these discussions. While physicians use objective disease severity and recent clinical events to trigger end-of-life discussions, it is not known if such findings predict patient readiness. We evaluated the ability of disease severity measures and recent clinical events to predict patient readiness for end-of-life discussions in patients with chronic lung disease.
Methods The desire for discussion about end-of-life care was evaluated in 100 outpatients with a diagnosis of chronic lung disease presenting for pulmonary function testing. Objective disease severity was indicated by the percentage of the predicted forced expiratory volume, use of oral corticosteroids, a functional status score, frequency of recent hospitalizations, and required use of mechanical ventilation.
Results In multivariate analysis, patient desire for an end-of-life discussion with the physician was not associated with percentage of predicted forced expiratory volume in 1 second (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.96-1.03), oral corticosteroid use (OR, 1.34; 95% CI, 0.40-4.54), functional status score (OR, 1.37; 95% CI, 0.34-5.56), hospitalizations in the past year (OR, 0.33; 95% CI, 0.09-1.20), or previous mechanical ventilation (OR, 1.37; 95% CI, 0.34-5.56).
Conclusions Patients appear no more or less interested in end-of-life discussions at later stages of chronic lung disease. Physicians cannot use disease severity measures or recent clinical events to accurately predict when patients desire end-of-life discussions. Focusing on physician skill in using specific communication strategies for patients at all stages of illness may be the most promising approach to increasing end-of-life discussions.
From the Divisions of General Internal Medicine (Drs Pfeifer and Mitchell) and Respiratory and Critical Care (Dr Chamberlain), Department of Medicine, University of Louisville, Louisville, Ky.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Referral and Timing of Referral to Hospice Care in Nursing Homes: The Significant Role of Staff Members
Welch et al.
Gerontologist 2008;48:477-484.
ABSTRACT
| FULL TEXT
A communication model for encouraging optimal care at the end of life for hospitalized patients
Workman
QJM 2007;100:791-797.
ABSTRACT
| FULL TEXT
Are there Racial Differences in Attitudes Toward Hospice Care? A Study of Hospice-Eligible Patients at the Visiting Nurse Service of New York
Rosenfeld et al.
AM J HOSP PALLIAT CARE 2007;24:408-416.
ABSTRACT
End-of-Life Health Care Planning Among Young-Old Adults: An Assessment of Psychosocial Influences
Carr and Khodyakov
J. Gerontol. B Psychol. Sci. Soc. Sci. 2007;62:S135-S141.
ABSTRACT
| FULL TEXT
Desire for hastened death in patients with advanced disease and the evidence base of clinical guidelines: a systematic review.
Hudson et al.
Palliat Med 2006;20:693-701.
ABSTRACT
Responding to desire to die statements from patients with advanced disease: recommendations for health professionals.
Hudson et al.
Palliat Med 2006;20:703-710.
ABSTRACT
Cardiopulmonary resuscitation: charting a course for the future
Workman
QJM 2006;99:711-715.
FULL TEXT
Medical Advance Care Planning for Persons With Serious Mental Illness
Foti et al.
Psychiatr. Serv. 2005;56:576-584.
ABSTRACT
| FULL TEXT
|
