Abstract
Context
Advance Care Planning is a process of understanding and sharing preferences regarding
future medical care.
Objective
To explore individual and national stability of end-of-life treatment preferences
among a sample of older adults.
Methods
National Health and Aging Trends Study is a nationally representative sample of older
adults. In 2012, a random sample, and in 2018, the entire sample were queried on end-of-life
treatment preferences defined as acceptance or rejection of life prolonging treatment
(LPT) if they had a serious illness and were at the end of their life and in severe
pain or had severe disability. Using a cohort design, we explored individual trends
in preferences for LPT among those with responses in both waves (pain scenario: N = 606, disability scenario: N = 628) and, using a serial cross-sectional design, national trends in LPT among the
entire sample (1702 older adults in wave 2 and 4342 in wave 8).
Results
In the cohort study, individual preferences were stable over time (overall percent
agreement = 86% for disability and 76% for pain scenarios), particularly for older
adults who would reject LPT in wave 2 (overall agreement 92% for disability and 86%
for pain). In the serial cross-sectional study, national trends in preferences for
receipt of LPT were stable over time in the pain (27.4% vs. 27.0%, P = 0.80) and disability (15.8% vs. 15.7%, P = 0.99) scenarios.
Conclusions
We found that national trends in preferences for end-of-life treatment did not substantially
change over time and may be stable within individual older adults.
Key Words
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References
- Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel.J Pain Symptom Manage. 2017; 53 (e1): 821-832
- Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment.J Am Geriatr Soc. 2007; 55: 1007-1014
- Changes in preferences for life-sustaining treatment among older persons with advanced illness.J Gen Intern Med. 2007; 22: 495-501
- Using the experiences of bereaved caregivers to inform patient- and caregiver-centered advance care planning.J Gen Intern Med. 2008; 23: 1602-1607
- The natural history of changes in preferences for life-sustaining treatments and implications for inpatient mortality in younger and older hospitalized adults.J Am Geriatr Soc. 2016; 64: 981-989
- Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences.Med Decis Making. 2006; 26: 313-322
- Physical functioning, depression, and preferences for treatment at the end of life: the Johns Hopkins precursors study.J Am Geriatr Soc. 2004; 52: 577-582
- Stability of end-of-life preferences: a systematic review of the evidence.JAMA Intern Med. 2014; 174: 1085-1092
- Stages of change for the component behaviors of advance care planning.J Am Geriatr Soc. 2010; 58: 2329-2336
- Stability of end-of-life preferences: a systematic review of the evidence.JAMA Intern Med. 2014; 174: 1085-1092
- The remarkable staying power of “death panels”.J Health Politics Policy Law. 2015; 40: 1087-1101
Kaiser Health Policy Tracking Poll: December 2014. Available at:https://www.kff.org/health-reform/poll-finding/kaiser-health-policy-tracking-poll-december-2014/. Accessed May 13, 2022.
- Key findings about Americans’ declining trust in government and each other.Pew Res Cent. 2019;
Hostetter M, Klein S. Understanding and ameliorating medical mistrust among Black Americans. the common wealth fund. Retrieved 2021;10:2021.
- Low completion and disparities in advance care planning activities among older Medicare beneficiaries.JAMA Intern Med. 2016; 176: 1872-1875
- What’s wrong with advance care planning?.JAMA. 2021; 326: 1575-1576
- Stability of choices about life-sustaining treatments.Ann Intern Med. 1994; 120: 567-573
- Older persons' opinions about life-sustaining procedures in the face of dementia.Arch Fam Med. 1999; 8: 421
Article info
Publication history
Published online: June 25, 2022
Accepted:
June 20,
2022
Footnotes
Paper presentation: None.
Identification
Copyright
© 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.