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End-of-life decision making: a qualitative study of elderly individuals
K E Rosenfeld1, N S Wenger, M Kagawa-Singer
1Division of General Internal Medicine, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. kenneth.rosenfeld@med.va.gov
Journal of General Internal Medicine
|October 13, 2000
Summary
Elderly individuals prioritize valued life activities over medical interventions in end-of-life decisions. Collaborative decision-making models involving physicians and families are recommended for better care alignment.
Area of Science:
- Gerontology
- Medical Ethics
- Sociology of Health
Background:
- End-of-life medical decision-making is complex for elderly individuals.
- Understanding patient preferences is crucial for ethical and effective care.
Purpose of the Study:
- To identify desired features of end-of-life medical decision-making from the perspective of elderly individuals.
- To inform advance care planning and physician-patient communication.
Main Methods:
- Qualitative study utilizing in-depth interviews.
- Phenomenological analysis of data from 21 elderly participants (mean age 83).
- Interviews conducted in Los Angeles senior living facilities.
Main Results:
- Participants prioritized return to valued life activities over specific medical interventions.
- Concerns about personal losses and a "full life" influenced decisions.
- Decision-making authority shifted between physicians and family based on prognosis.
Conclusions:
- Advance directives should focus on acceptable health states and valued life activities.
- A collaborative model of surrogate decision-making between physicians and families is proposed.
- Physicians should recommend treatment plans aligned with patient and family goals.