Over time, older people change their preferences for end-of-life care and are more willing to accept treatment resulting in physical disability than treatment resulting in cognitive disability, researchers at the School of Medicine report in the current Archives of Internal Medicine.
Advance care planning, the process by which patients indicate the medical care they would want to receive if they could no longer make decisions for themselves, asks patients to indicate whether they would want various life-sustaining treatments.
"This process asks patients to predict what their future preferences would be, and therefore assumes that preferences will not change over time," says first author Dr. Terri Fried, associate professor of internal medicine, geriatrics. "This study demonstrated that patients' preferences changed over time and with changes in their health state, raising questions about patients' abilities to predict their future preferences."
Trained research assistants conducted in-home interviews with 226 persons who were age 60 and older and seriously ill with cancer, congestive heart failure or chronic obstructive pulmonary disease. Interviews were conducted at least every four months for up to two years and more frequently with changes in the patient's health status.
Patients facing a worsening of illness were asked to rate whether treatment for their illness would be acceptable if it resulted in a series of health states. A rating of "unacceptable" meant they would prefer to die than to receive treatment.
Over time, patients became more likely to rate as acceptable treatment resulting in mild or severe physical disability. Patients who experienced a decline in their ability to perform complex activities of daily living were more likely to rate treatment resulting in mild or severe disability as acceptable. These patients became less likely over time to rate as acceptable treatment that would result in severe cognitive disability.
Other authors on the study were Amy L. Byers, William T. Gallo, Peter H. Van Ness, Virginia R. Towle, John R. O'Leary and Joel A. Dubin.
-- By Karen Peart
T H I S
W E E K ' SS T O R I E S
Scientists identify new genus of monkey; first in 83 years
Divinity Dean reappointed to second term
Yale to celebrate 305th Commencement
Student photographs 'hidden beauty in everyday life'
Summertime at Yale
Brownell cited as one of world's '100 most influential people'
President Levin honored for increasing town-gown partnerships
ENDOWED PROFESSORSHIPS
David Bromwich appointed Sterling Professor of English
David Louis Quint named Sterling Professor of Comparative Literature
Brown-Dean is appointed Peter Strauss Family Assistant Professor
Four individuals will bring their expertise . . . to SOM
Two noted violinists . . . join the faculty of the School of Music
Three residential college masters named to second term
Laura Cruickshank named to post of University planner
Exhibit features English silver pieces once owned by tsars
Exhibits look back at 40 years of chiming bells and more
Major renovation effort begins at Cross Campus Librar
MEDICAL SCHOOL NEWS
Study confirms usefulness of naltrexone . . .
Treatment preferences for end-of-life care change with time . . .
Research shows medication may delay onset of psychosis
Claus will study genetics of breast cancer with Komen Foundation grant
Eight graduating seniors are bound for China as teaching fellows
IN MEMORIAM
Albert J. Reiss Jr., work led to reforms in policing
Dr. Norman Siegel, a world-renowned specialist on kidney disease . . .
Jaroslav Pelikan, noted scholar of Christianity, dies
Memorial service for William Sloan Coffin to be held May 27
Yale's nurse-midwives celebrate 50 years of community care
Talk will focus on life extension and human right
'Keepers of the Dream' to look at advancing urban education
Sociologist Adams honored for book on 'The Familial State'
Association honors Yale-affiliated scientists and engineers . . .
Journal of Industrial Ecology marks two milestones . . .
Grant will fund research on how human speech is shaped
'Trouble in Tahiti' to be performed during School of Music alumni weekend
Campaign invites community to 'Plant a Row for the Hungry'
Campus Notes
Bulletin Home|Visiting on Campus|Calendar of Events|In the News
Bulletin Board|Classified Ads|Search Archives|Deadlines
Bulletin Staff|Public Affairs|News Releases|
E-Mail Us|Yale Home