Predictors of patient treatment preferences and spouse substituted judgments: the case of dialysis continuation

Medical Decision Making : an International Journal of the Society for Medical Decision Making
Rachel A PruchnoNorman G Levinsky

Abstract

To examine the factors predicting preferences for continued hemodialysis treatment among patients with endstage renal disease (ESRD) and to compare these factors to those predicting their spouses' predictions of patients' preferences (substituted judgments). Descriptive, cross-sectional. Total of 291 hemodialysis patients, aged 55 years and older, and their spouses. Hypothetical scenarios were designed to elicit preferences for dialysis continuation under various health conditions. Other measures included the Philadelphia Geriatric Center Negative Affect Scale, Kidney Disease Symptoms Scale, Brief Multidimensional Measure of Religiousness, single-item global subjective health and quality-of-life measures, 2-item fear of end-of-life suffering measure, and selected demographics. Patients' preferences and spouses' judgments were only moderately correlated (r = 0.33). Multiple regression analyses revealed that patients' preferences to continue dialysis were positively related to education, subjective quality of life, and religious participation and negatively related to months of ESRD treatment and fear of end-of-life suffering (R(2) = 0.15). Spouses' substituted judgments regarding patients' dialysis continuation preferences were ...Continue Reading

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