PATIENT PREFERENCES FOR COMMUNICATION WITH PHYSICIANS ABOUT END-OF-LIFE DECISIONS

Background: Physicians are frequently unaware of patient preferences f or end-of-life care. Identifying and exploring barriers to patient-phy sician communication about end-of-life issues may help guide physician s and their patients toward more effective discussions. Objective: To examine correlates and associated outcomes of patient communication an d patient preferences for communication with physicians about cardiopu lmonary resuscitation and prolonged mechanical ventilation. Design: Pr ospective cohort study. Setting: Five tertiary care hospitals. Patient s: 1832 (85%) of 2162 eligible patients completed interviews. Measurem ents: Surveys of patient characteristics and preferences for end-of-li fe care; perceptions of prognosis, decision making, and quality of lif e; and patient preferences for communication with physicians about end -of-life decisions. Results: Fewer than one fourth (23%) of seriously ill patients had discussed preferences for cardiopulmonary resuscitati on with their physicians. Of patients who had not discussed their pref erences for resuscitation, 58% were not interested in doing so. Of pat ients who had not discussed and did not want to discuss their preferen ces, 25% did not want resuscitation. In multivariable analyses, patien t factors independently associated with not wanting to discuss prefere nces for cardiopulmonary resuscitation included being of an ethnicity other than black (adjusted odds ratio [OR]I 1.48 [95% CI, 1.10 to 1.99 ), not having an advance directive (OR, 1.35 [CI, 1.04 to 1.76]), esti mating an excellent prognosis (OR, 1.72 [Cl, 1.32 to 2.59]), reporting fair to excellent quality of life (OR, 1.36 [CI, 1.05 to 1.76]), and not desiring active involvement in medical decisions (OR, 1.33 [Ci, 1. 07 to 1.65]). Factors independently associated with wanting to discuss preferences for resuscitation but not doing so included being black ( OR, 1.53 [CI, 1.11 to 2.11]) and being younger (OR, 1.14 per 10-year i nterval younger [CI, 1.04 to 1.25]). Conclusions: Among seriously ill hospitalized adults, communication about preferences for cardiopulmona ry resuscitation is uncommon. A majority of patients who have not disc ussed preferences for end-of-life care do not want to do so. For patie nts who do not want to discuss their preferences, as well as patients with an unmet need for such discussions, failure to discuss preference s for cardiopulmonary resuscitation and mechanical ventilation may res ult in unwanted interventions.