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).
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.
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.
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.