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Original Research |

Instability of willingness to accept life-sustaining treatments of patients with advanced chronic organ failure during one year

Carmen H.M. Houben, MSc; Martijn A. Spruit, PhD; Jos M.G.A. Schols, MD, PhD; Emiel F.M. Wouters, MD, PhD; Daisy J.A. Janssen, MD, PhD
Author and Funding Information

Conflicts of interests: None of the authors have any potential conflicts of interest to disclose.

Clinical Trial registration: NTR 1552.

1Department of Research & Education, CIRO, Horn, the Netherlands

2Department of Family Medicine and Department of Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands

3Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands

4Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, the Netherlands

Address of correspondence: Carmen H.M. Houben, MSc., Department of Research & Education, CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.12.003
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Abstract

Background  For optimal end-of-life decision-making, it is important to understand the stability of patients’ treatment preferences. The aim of this article is to examine stability of willingness to accept life-sustaining treatments during one-year follow-up in Dutch patients with advanced chronic organ failure. In addition, we want to explore the association between willingness to accept high-burden treatment and preferences for cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV).

Methods  In this multicenter, longitudinal study 265 clinically stable outpatients with advanced COPD (GOLD-stage III/IV, n=105), chronic heart failure (NYHA-class III/IV, n=80), or chronic renal failure (requiring dialysis, n=80) were visited at baseline, 4, 8 and 12 months to assess stability of life-sustaining treatment preferences using the Willingness to Accept Life-sustaining Treatment (WALT) instrument.

Results  206 patients completed one-year follow-up (mean age 67.2 (13.1) years; 64.1% male). Overall, proportions of patients who were willing to accept life-sustaining treatment during one year did not change over time. However, individual trajectories showed that about two third of patients changed their preferences at least once during a year. Moreover, there was no association found between stability of willingness to undergo high-burden therapy and stability of preferences for CPR and MV.

Conclusion  The current findings show the complexity of preferences for end-of-life care and indicated once again that advance care planning (ACP) is a continuous process between patients and physicians, in which preferences for specific situations were discussed and which needs to be regularly reevaluated in order to deliver high-quality end-of-life care.


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