Living Wills Often Do Not Reflect Actual Treatment
Preferences as End of Life Nears
Hypothetical end-of-life scenario presented in the
standard living will is often quite different than the circumstances
patients will actually face
May
19, 2010 - Living wills often do not represent a patient's actual
treatment preferences when faced with real end-of-life circumstances and
should be redesigned to guide more realistic advance decision-making,
according to a study published in Journal of Palliative Medicine.
"Ask a Different Question, Get a Different Answer:
Why Living Wills are Poor Guides to Care Preferences at the End of Life"
is the title of this study designed to assess how closely responses to
questions on a standard living will represent an individual's
preferences for end-of-life care in six different scenarios.
Often no easy way to navigate between
an acceptable quality of life and a death with dignity: octogenarian had
planned for everything — until a stroke put her in limbo
Laraine Winter, PhD, Susan Parks, MD, and James
Diamond, PhD, from Thomas Jefferson University in Philadelphia, PA,
surveyed 202 men and women 70 years of age or older and asked them
whether they would want life-sustaining treatments to be withheld if
they served only to prolong the process of dying, a standard question on
a living will.
They then asked the study participants to predict
their preferences for receiving four specific treatments in six
end-of-life scenarios.
The results demonstrated that although there was
some association between the living will response and treatment
preferences in the six scenarios, these associations were relatively
weak.
The authors suggest that the hypothetical
end-of-life scenario presented in the standard living will is often
quite different than the circumstances patients will actually face,
which accounts at least in part for the weak link between their
responses on the living will and their treatment preferences.
The authors propose substituting in the living will
scenarios that more closely approximate what people are likely to
experience and including estimates of how effective specific treatment
options would be in sustaining life to help guide advance care
decisions.
"It is so important to move the field of advance
care planning forward," says Charles F. von Gunten, MD, PhD,
Editor-in-Chief of Journal of Palliative Medicine, and Provost,
Institute for Palliative Medicine at San Diego Hospice.
Further, he adds, "This should form the basis for
innovative new approaches for help in decision-making."
The Journal of Palliative Medicine is a
peer-reviewed journal from Mary Ann Liebert, Inc., (www.liebertpub.com).
It is the official journal of the Center to Advance Palliative Care (CAPC)
and an official journal of the Hospice and Palliative Nurses Association
(HPNA). The paper is available free online (www.liebertpub.com/jpm).
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