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Physical functioning, depression, and preferences for treatment at the end of life: the Johns Hopkins Precursors
Joseph B Straton1, Nae-Yuh Wang, Lucy A Meoni
1Department of Family Practice and Community Medicine, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvannia School of Medicine, Philadelphia, 19104, USA. joseph.straton@uphs.upenn.edu
Objectives:
To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment.
Design:
Mailed survey of older physicians.
Setting:
Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.
Participants:
Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68).
Measurements:
Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.
Results:
Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18-3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60-17.8) to prefer high-burden treatment than respondents without declining function or worsening depression.
Conclusion:
This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.
