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Perceived Quality of Life and Preferences for Life-Sustaining Treatment in Older Adults

Perceived Quality of Life and Preferences for Life-Sustaining Treatment in Older Adults Abstract We investigated whether perceived quality of life is associated with preferences for life-sustaining treatment for older adults. Participants included chronically ill, elderly outpatients (N = 258) and their primary physicians (N 105). Patients and physicians were independently administered a questionnaire regarding patient quality of life and preferences for cardiopulmonary resuscitation and mechanical ventilation for the patient. Physicians rated patients' global quality of life, physical comfort, mobility, depression, anxiety, and family relationships significantly worse than did patients. Nearly all perceptions of patients' quality of life were significantly associated with physicians' perceptions, but not patients' treatment preferences. Patient-physician agreement on patient global quality of life was not significantly associated with agreement regarding treatment preferences. We conclude that primary physicians generally consider their older outpatients' quality of life to be worse than do the patients. Furthermore, physicians' estimations of patient quality of life are significantly associated with physicians' attitudes toward lifesustaining treatment for the patients. For the patients, however, perceived quality of life does not appear to be associated with their preferences for life-sustaining treatment. (Arch Intern Med. 1991;151:495-497) References 1. Lo B, Jonsen AR. Clinical decisions to limit treatment . Ann Intern Med. 1980;93:764-768.Crossref 2. Pearlman RA, Jonsen A. The use of quality of life considerations in medical decision-making . J Am Geriatr Soc. 1985;33:344-352. 3. Starr TJ, Pearlman RA, Uhlmann RF. Quality of life and resuscitation decisions in elderly patients . J Gen Intern Med. 1986;1:373-379.Crossref 4. Pearlman RA, Uhlmann RF. Patient and physician perceptions of patient quality of life across chronic diseases . J Gerontol. 1988;43:M25-30.Crossref 5. Uhlmann RF, McDonald WJ, Inui TS. Epidemiology of no-code orders in an academic hospital . West J Med. 1984;140:114-116. 6. Lo B, Saika MA, Strull W, Thomas E, Showstack J. 'Do not resuscitate' decisions: a prospective study at three teaching hospitals . Arch Intern Med. 1985;145:1115-1117.Crossref 7. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital . N Engl J Med. 1984;310:1089-1093.Crossref 8. Uhlmann RF, Pearlman RA, Cain KB. Physicians' and spouses' predictions of elderly patients' resuscitation preferences . J Gerontol. 1988;43:M115121.Crossref 9. Danis M, Patrick DL, Southerland LI, Green ML. Patients' and families' preferences for medical intensive care . JAMA. 1988;260:797-802.Crossref 10. Uhlmann RF, Pearlman RA, Cain KC. Understanding of elderly patients' resuscitation preferences by physicians and nurses . West J Med. 1989;150:705-707. 11. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12:189-198.Crossref 12. Friedman LM, Furberg CD, DeMets DL. Fundamentals of Clinical Trials. 2nd ed. Littleton, Mass: PSG Publishing Co Inc; 1985. 13. Abbey A, Andrews FM. Modelling the psychological determinants of life quality . Soc Indicators Res. 1985;16:1-34.Crossref 14. Campbell A, Converse PE, Rodgers WL. The Quality of American Life . New York, NY: Russell Sage Foundation; 1976. 15. Pearlman RA, Uhlmann RF. Quality of life in chronically ill, elderly outpatients . J Gerontol . In press. 16. Everhart MA, Pearlman RA. Stability of patient preferences regarding life-sustaining treatments . Chest. 1990;97:159-164.Crossref 17. Williams ME, Hadler NM. The illness as the focus of geriatric medicine . N Engl J Med. 1983;308:1357-1359.Crossref 18. Perry JS, Thomas P. Attitudes toward present and expected life satisfaction for self and others . Psychol Rep. 1980;47:1086.Crossref 19. McNeil BJ, Weichselbaum R, Pauker SG. Fallacy of the five-year survival in lung cancer . N Engl J Med. 1978;299:1397-1401.Crossref 20. McNeil BJ, Weichselbaum R, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer . N Engl J Med. 1981;305:982-987.Crossref 21. Frankl D, Oye R, Bellamy PE. Attitudes of hospitalized patients toward life support: a survey of 200 medical inpatients . Am J Med. 1989;86:645-648.Crossref 22. Pearlman RA, Inui TS, Carter WB. Variability in physician bioethical decision-making: a case study of euthanasia . Ann Intern Med. 1982;97:420-425.Crossref 23. Hyers TM, Briggs DD, Hudson LD, et al. Withholding and withdrawing mechanical ventilation . Am Rev Respir Dis. 1986;134:1327-1330. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Perceived Quality of Life and Preferences for Life-Sustaining Treatment in Older Adults

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400030059010
Publisher site
See Article on Publisher Site

Abstract

Abstract We investigated whether perceived quality of life is associated with preferences for life-sustaining treatment for older adults. Participants included chronically ill, elderly outpatients (N = 258) and their primary physicians (N 105). Patients and physicians were independently administered a questionnaire regarding patient quality of life and preferences for cardiopulmonary resuscitation and mechanical ventilation for the patient. Physicians rated patients' global quality of life, physical comfort, mobility, depression, anxiety, and family relationships significantly worse than did patients. Nearly all perceptions of patients' quality of life were significantly associated with physicians' perceptions, but not patients' treatment preferences. Patient-physician agreement on patient global quality of life was not significantly associated with agreement regarding treatment preferences. We conclude that primary physicians generally consider their older outpatients' quality of life to be worse than do the patients. Furthermore, physicians' estimations of patient quality of life are significantly associated with physicians' attitudes toward lifesustaining treatment for the patients. For the patients, however, perceived quality of life does not appear to be associated with their preferences for life-sustaining treatment. (Arch Intern Med. 1991;151:495-497) References 1. Lo B, Jonsen AR. Clinical decisions to limit treatment . Ann Intern Med. 1980;93:764-768.Crossref 2. Pearlman RA, Jonsen A. The use of quality of life considerations in medical decision-making . J Am Geriatr Soc. 1985;33:344-352. 3. Starr TJ, Pearlman RA, Uhlmann RF. Quality of life and resuscitation decisions in elderly patients . J Gen Intern Med. 1986;1:373-379.Crossref 4. Pearlman RA, Uhlmann RF. Patient and physician perceptions of patient quality of life across chronic diseases . J Gerontol. 1988;43:M25-30.Crossref 5. Uhlmann RF, McDonald WJ, Inui TS. Epidemiology of no-code orders in an academic hospital . West J Med. 1984;140:114-116. 6. Lo B, Saika MA, Strull W, Thomas E, Showstack J. 'Do not resuscitate' decisions: a prospective study at three teaching hospitals . Arch Intern Med. 1985;145:1115-1117.Crossref 7. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital . N Engl J Med. 1984;310:1089-1093.Crossref 8. Uhlmann RF, Pearlman RA, Cain KB. Physicians' and spouses' predictions of elderly patients' resuscitation preferences . J Gerontol. 1988;43:M115121.Crossref 9. Danis M, Patrick DL, Southerland LI, Green ML. Patients' and families' preferences for medical intensive care . JAMA. 1988;260:797-802.Crossref 10. Uhlmann RF, Pearlman RA, Cain KC. Understanding of elderly patients' resuscitation preferences by physicians and nurses . West J Med. 1989;150:705-707. 11. Folstein MF, Folstein SE, McHugh PR. 'Mini-mental state': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12:189-198.Crossref 12. Friedman LM, Furberg CD, DeMets DL. Fundamentals of Clinical Trials. 2nd ed. Littleton, Mass: PSG Publishing Co Inc; 1985. 13. Abbey A, Andrews FM. Modelling the psychological determinants of life quality . Soc Indicators Res. 1985;16:1-34.Crossref 14. Campbell A, Converse PE, Rodgers WL. The Quality of American Life . New York, NY: Russell Sage Foundation; 1976. 15. Pearlman RA, Uhlmann RF. Quality of life in chronically ill, elderly outpatients . J Gerontol . In press. 16. Everhart MA, Pearlman RA. Stability of patient preferences regarding life-sustaining treatments . Chest. 1990;97:159-164.Crossref 17. Williams ME, Hadler NM. The illness as the focus of geriatric medicine . N Engl J Med. 1983;308:1357-1359.Crossref 18. Perry JS, Thomas P. Attitudes toward present and expected life satisfaction for self and others . Psychol Rep. 1980;47:1086.Crossref 19. McNeil BJ, Weichselbaum R, Pauker SG. Fallacy of the five-year survival in lung cancer . N Engl J Med. 1978;299:1397-1401.Crossref 20. McNeil BJ, Weichselbaum R, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer . N Engl J Med. 1981;305:982-987.Crossref 21. Frankl D, Oye R, Bellamy PE. Attitudes of hospitalized patients toward life support: a survey of 200 medical inpatients . Am J Med. 1989;86:645-648.Crossref 22. Pearlman RA, Inui TS, Carter WB. Variability in physician bioethical decision-making: a case study of euthanasia . Ann Intern Med. 1982;97:420-425.Crossref 23. Hyers TM, Briggs DD, Hudson LD, et al. Withholding and withdrawing mechanical ventilation . Am Rev Respir Dis. 1986;134:1327-1330.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1991

References