Comparing utilization of life-sustaining treatments with patient and public preferences

Journal of General Internal Medicine
H R Alpert, L L Emanuel

Abstract

The movement for advance planning of end-of-life care was motivated in part by the assumption that medical intervention for terminally ill patients varies from what these patients would prefer. We examined the validity of this assumption by comparing actual life-sustaining treatment practices for patients in critical illness scenarios and surveyed patients' advance care preferences. We selected at random and reviewed 7,400 inpatient medical records from a single urban teaching hospital during the period just prior to the Patient Self-Determination Act. Records of 198 patients with conditions that matched advance directive scenarios were examined, and practices to withhold or withdraw seven life-sustaining treatments were documented. Practices were compared with surveyed preferences of 102 members of the general public and 495 outpatients who were followed by the same physicians as the 198 patients. Concordance of practices and preferences for the 19 surveyed outpatients who eventually fell into one of the scenarios was also evaluated. One hundred sixty-seven inpatient cases met review criteria for the scenario coma with a small chance of recovery. Hospital patients received medical interventions that were not consistently great...Continue Reading

References

May 1, 1992·Critical Care Medicine·K Faber-Langendoen, D M Bartels
Jan 1, 1992·JAMA : the Journal of the American Medical Association·A SehgalB Lo
Apr 15, 1992·JAMA : the Journal of the American Medical Association·E J Emanuel, L L Emanuel
Mar 28, 1991·The New England Journal of Medicine·M DanisD L Patrick
Mar 28, 1991·The New England Journal of Medicine·L L EmanuelE J Emanuel
Jul 15, 1991·Annals of Internal Medicine·A B SecklerB E Paris
Feb 1, 1990·The New England Journal of Medicine·N G SmediraC May
Jun 1, 1989·Archives of Internal Medicine·J G OuslanderB Rahbar
Aug 12, 1988·JAMA : the Journal of the American Medical Association·T A Brennan
Apr 14, 1983·The New England Journal of Medicine·J P Kassirer
Nov 1, 1994·Journal of General Internal Medicine·G S Fischer, R M Arnold
Sep 26, 1994·Archives of Internal Medicine·W B WeeksH G Welch
Nov 22, 1993·Archives of Internal Medicine·M R GillickN Mazzapica
Jan 24, 1994·Archives of Internal Medicine·L L EmanuelM J Barry
Jan 1, 1993·American Journal of Public Health·M Z SolomonS Donnelley
Sep 1, 1995·Journal of General Internal Medicine·N A Christakis, D A Asch
Sep 5, 1996·The New England Journal of Medicine·N G Levinsky
Sep 5, 1996·The New England Journal of Medicine·D Callahan
Oct 1, 1996·Medical Care·H R AlpertL Emanuel

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Citations

Jul 3, 2007·HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues·Mark R Tonelli
Aug 30, 2003·Journal of the American College of Surgeons·Anne C Mosenthal, Patricia A Murphy
Oct 12, 2001·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·E L MarcusA E Moses
Sep 16, 2003·Critical Care Medicine·Jeffrey P BurnsTroyen A Brennan
Aug 12, 2014·Journal of Community Health·Nathan A BoucherMaria Alejandro
Dec 29, 2000·Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine·S M Auerbach
Jan 16, 2003·Chest·John P GriffinUNKNOWN American College of Chest Physicians
Dec 14, 2011·Annales Françaises D'anesthèsie Et De Rèanimation·R PirracchioD Payen
Jun 6, 2007·Journal of Critical Care·Judith Gedney BaggsJill R Quinn
Aug 20, 2004·Journal of Clinical Nursing·Sandra K Eggenberger, Tommie P Nelms
Apr 12, 2012·Worldviews on Evidence-based Nursing·Jennifer KryworuchkoDean A Fergusson
Jun 16, 2004·Nursing Outlook·Mi-Kyung Song
Sep 4, 2014·Journal of Medical Ethics·Matthijs P S van WijmenBregje D Onwuteaka-Philipsen
Apr 4, 2021·International Journal of Environmental Research and Public Health·Chih-Chieh YenJin-Shang Wu

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