A PROSPECTIVE-STUDY OF THE IMPACT OF PATIENT PREFERENCES ON LIFE-SUSTAINING TREATMENT AND HOSPITAL COST

Objectives: Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, th ere has been little systematic study of the impact of patient preferen ces on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective study was designed to answer the following questions: a) Do patient treatment preferences about the use of life-sustaining treatment influence the treatments they receiv e? and b) Do patient treatment preferences influence the total cost of their hospitalization? Design: A prospective, cohort study. Setting: A university teaching hospital. Patients: Hospitalized patients, at le ast 50 yrs of age, with short life expectancy due to end-stage heart, lung, or liver disease, metastatic cancer, or lymphoma. Interventions: None. Measurements and Main Results: Patients were interviewed to det ermine their desire for life-sustaining treatment and other characteri stics and then were followed for 6 months to determine life-sustaining treatment use and costs during hospitalization. Two hundred forty-fou r patients were interviewed. Fifty-eight percent of patients expressed a desire for life-sustaining treatments to prolong life for 1 wk. Dur ing 245 subsequent hospitalizations, there were 20 episodes of mechani cal ventilation, 63 episodes of intensive care, and 66 cancer treatmen ts given. Bivariate and multivariate analyses showed no significant as sociation between patient desire to receive treatment to prolong life and either life sustaining treatment use (p=.59) or hospital costs (p= .20). Conclusion: In a university teaching hospital setting, there is no systematic evidence that patient preferences determine life-sustain ing treatment use or hospital costs.