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Cited by 155Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareFrailty in Older Adults

Prospective Study of Health Status PREFERENCES and Changes in PREFERENCES Over Time in Older Adults

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Fried, Terri R., Byers, Amy L., Gallo, William T., Van Ness, Peter H., Towle, Virginia R., O’Leary, John R., Dubin, Joel A.·2006·Archives of Internal Medicine
DOI 10.1001/archinte.166.8.890PMC PMC1978221
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Abstract

BACKGROUND: Instructional forms of advance care planning depend on the ability of patients to predict their future treatment preferences. However, preferences may change with changes in patients' health states. METHODS: We conducted in-home interviews of 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease at least every 4 months for up to 2 years. Patients were asked to rate whether treatment for their illness would be acceptable if it resulted in 1 of 4 health states. RESULTS: The likelihood of rating as acceptable a treatment resulting in mild (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06-1.16) or severe (OR, 1.06; 95% CI, 1.03-1.09) functional disability increased with each month of participation. Patients who experienced a decline in their ability to perform instrumental activities of daily living were more likely to rate as acceptable treatment resulting in mild (OR, 1.23; 95% CI, 1.08-1.40) or severe (OR, 1.23; 95% CI, 1.11-1.37) disability. Although the overall likelihood of rating treatment resulting in a state of pain as acceptable did not change over time (OR, 0.98; 95% CI, 0.96-1.01), patients who had moderate to severe pain were more likely to rate this treatment as acceptable (OR, 2.55; 95% CI, 1.56-4.19) than were those who did not have moderate to severe pain. CONCLUSIONS: For some patients, the acceptability of treatment resulting in certain diminished states of health increases with time, and increased acceptability is more likely among patients experiencing a decline in that same domain. These changes pose a challenge to advance care planning, which asks patients to predict their future treatment preferences.

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  • Patient preferences for outcomes and the level of burden acceptable to a patient may change as illness progresses.

    “because patient preferences for outcomes and the level of burden acceptable to a patient may change as illness progresses.49”

    From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [49]

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  1. [21]The Connecticut Hospice I . Summary Guidelines for Initiation of Advanced Care. John Thompson Institute; Branford, CT: 1996. [Google Scholar]
  2. [33]SAS Institute Inc. The NLMIXED Procedure. SAS/STAT User's Guide. SAS Institute Inc.; Cary, NC: 1999. Version 8. [Google Scholar]
  3. [35]Pearlman RA, Starks HE, Cain KC, Cole WG, Patrick DL, Uhlmann RF. Integrating preferences for life-sustaining treatments and health state ratings into meaningful advance care discussions. In: van der Maas PJ, editor. Proceedings from the Royal Netherlands Academy of Arts and Sciences Colloquium on Epidemiological and Clinical Aspects of End-of-life Decision-Making; 2001. [Google Scholar]

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Authors
Fried, T. R., Byers, A. L., Gallo, W. T., Van Ness, P. H., Towle, V. R., O’Leary, J. R., & Dubin, J. A.
Affiliations
Yale University (US)
ORCID
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2006-04-24
Volume
166
Issue
8
Pages
890
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.166.8.890
PMC
PMC1978221
OpenAlex
W1987032817
Cited by
155
References
40
Citations by year
2026: 2 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 4 · 2019: 9 · 2018: 6 · 2017: 9 · 2016: 9 · 2015: 6 · 2014: 12 · 2013: 5 · 2012: 12
FWCI
11.32
Type
journal article
Language
en
Open access
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
National Institute on Aging (K02AG20113, R01AG019769, K02AG020113, P30 AG21342, R01 AG19769, P30AG021342)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords
advance care planning, treatment acceptability, health state preferences, older adults, functional disability, instrumental activities of daily living, pain, advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, preference change over time, community-dwelling patients
MeSH terms
Activities of Daily Living, Aged, Disability Evaluation, Female, Follow-Up Studies, Health Status, Heart Failure, Humans, Male, Middle Aged, Neoplasms, Prognosis, Prospective Studies, Time Factors, Disease Progression, Pulmonary Disease, Chronic Obstructive

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