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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/13727

Title: Predicting Changes in Preferences for Life-Sustaining Treatment Among Patients With Advanced Chronic Organ Failure
Authors: Janssen, Daisy J. A.
Spruit, Martijn A.
Schols, Jos M. G. A.
Cox, Bianca
Nawrot, Tim S.
Curtis, J. Randall
Wouters, Emiel F. M.
Issue Date: 2012
Citation: CHEST, 141 (5), p. 1251-1259
Abstract: Background: For physicians discussing advance care planning with patients with life-limiting illness, it is important to understand the stability of the patients' preferences for life-sustaining treatments and the factors that predict a change in preferences. Our objectives were to investigate 1-year stability of preferences regarding CPR and mechanical ventilation (MV) for outpatients with advanced COPD, chronic heart failure (CHF), or chronic renal failure (CRF) and to identify predictors of changes in preferences. Methods: In this study, 265 clinically stable outpatients with advanced COPD, CHF, or CRF were visited at baseline and every 4 months for 1 year to assess preferences regarding CPR and MV in their current health status. Generalized estimating equations were used to examine the association between change in life-sustaining treatment preferences and several potential predictors, including changes in comorbidities, hospital admissions, genetic health status, care dependency, mobility, and symptoms of anxiety or depression. Results: The 1-year follow-up period was completed by 77.7% of the patients. Preferences regarding CPR or MV changed in 38.3% of the patients during the follow-up period. Changes over time in generic health status, mobility, symptoms of anxiety and depression, and marital status were associated with changes in life-sustaining treatment preferences. Conclusions: More than one-third of outpatients with advanced COPD, CHF, or CRF change their preferences regarding CPR and/or nv at least once during 1 year. Regular reevaluation of advance care planning is necessary, in particular when patients experience a change in health status, mobility, symptoms of anxiety or depression, or marital status. Trial registry: Netherlands National Trial Register; No.: NTR 1552; UHL: http://www.trialregister.nl CHEST 2012; 141(5):1251-1259
Notes: [Janssen, Daisy J. A.; Spruit, Martijn A.; Wouters, Emiel F. M.] Ctr Expertise Chron Organ Failure, CIRO, Program Dev Ctr, NL-6085 NM Horn, Netherlands. [Janssen, Daisy J. A.] Prote Thuis, Horn, Netherlands. [Janssen, Daisy J. A.] Maastricht Univ, Maastricht Univ Med Ctr, CAPHRI, Maastricht, Netherlands. [Schols, Jos M. G. A.] Maastricht Univ, Maastricht Univ Med Ctr, Fac Hlth Med & Life Sci CAPHRI, Dept Gen Practice, Maastricht, Netherlands. [Wouters, Emiel F. M.] Maastricht Univ, Maastricht Univ Med Ctr, Dept Resp Med, Maastricht, Netherlands. [Cox, Bianca; Nawrot, Tim S.] Hasselt Univ, Ctr Environm Sci, Diepenbeek, Belgium. [Curtis, J. Randall] Univ Washington, Harborview Med Ctr, Dept Med, Div Pulm & Crit Care Med, Seattle, WA 98104 USA.
URI: http://hdl.handle.net/1942/13727
DOI: 10.1378/chest.11-1472
ISI #: 000303905700023
ISSN: 0012-3692
Category: A1
Type: Journal Contribution
Validation: ecoom, 2013
Appears in Collections: Research publications

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