Journal of Bioethical Inquiry

, Volume 10, Issue 1, pp 103–114 | Cite as

Stability Over Time in the Preferences of Older Persons for Life-Sustaining Treatment

  • Ines M. Barrio-Cantalejo
  • Pablo Simón-Lorda
  • Adoración Molina-Ruiz
  • Fátima Herrera-Ramos
  • Encarnación Martínez-Cruz
  • Rosa Maria Bailon-Gómez
  • Antonio López-Rico
  • Patricia Peinado Gorlat
Original Research

Abstract

Objective: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. Design: Longitudinal cohort study. Setting: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. Results: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. Conclusion: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.

Keywords

End of life Decision-making Advance directives Advance care planning 

Notes

Acknowledgments

This article is based on the research project 506 “Stability of Life-Sustaining Preferences in Older People” 507 (PI2008/362), funded by the Andalusia Health Ministry. We also want to thank Maria del Mar Rodriguez del Águila and Sabina Pérez Vicente for their support in the statistical analysis.

Statement of Competing Interests

No potential conflicts of interest are reported by the authors.

References

  1. Barrio-Cantalejo, I.M., R.M. Bailón-Gómez, M.C. Cámara-Medina, M.A. Carmona Cabezas, M.E. Martinez Cruz, and P. Quesada Lupiáñez. 2008. Validation of the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Atencion Primaria 40(7): 345–349.PubMedCrossRefGoogle Scholar
  2. Barrio-Cantalejo, I.M., A. Molina-Ruiz, P. Simón-Lorda, et al. 2009. Advance directives and proxies’ predictions about patients’ treatment preferences. Nursing Ethics 16(1): 93–109.PubMedCrossRefGoogle Scholar
  3. Beland, D.K., and R.D. Froman. 1995. Preliminary validation of a measurement of life support preferences. Journal of Nursing Scholarship 27(4): 307–310.CrossRefGoogle Scholar
  4. Bellón-Saameño, J.A., A. Delgado-Sánchez, J.D. Luna del Castillo, and P. Lardelli Claret. 1996. Validity and reliability of the Family APGAR family function test. Atencion Primaria 18(6): 289–296.PubMedGoogle Scholar
  5. Centro de Investigaciones Sociológicas [Centre for Sociological Research] (CIS). 2010. Atención a pacientes con enfermedades en fase terminal [Care for patients with terminal illness], study 2803, May–June 2009. Madrid: CIS.Google Scholar
  6. Danis, M., J. Garrett, R. Harris, and D.L. Patrick. 1994. Stability of choices about life-sustaining treatment. Annals of Internal Medicine 120(7): 567–573.PubMedCrossRefGoogle Scholar
  7. Ditto, P.H., W.D. Smucker, J.H. Danks, et al. 2003. The Stability of older adults’ preferences for life-sustaining medical treatment. Health Psychology 22(6): 605–615.PubMedCrossRefGoogle Scholar
  8. Elías, Norbert. 1987. La soledad de los moribundos [The loneliness of the dying]. Trans. C. Martín. Madrid: Fondo de Cultura Económica de España. Originally published as Über die Einsamkeit der Sterbenden in unseren Tagen (Frankfurt am Main: Suhrkamp, 1982).Google Scholar
  9. Everhat, M.A., and R.A. Pearlman. 1990. Stability of patient preferences regarding life-sustaining treatments. Chest 97(1): 159–164.CrossRefGoogle Scholar
  10. Fagerlin, A., and C.E. Schneider. 2004. Enough: The failure of the living will. The Hastings Center Report 34(2): 30–42.PubMedCrossRefGoogle Scholar
  11. Fried, T.R., A.L. Byers, W.T. Gallo, et al. 2006. Prospective study of health status preferences and changes in preferences over time in older adults. Archives of Internal Medicine 166(8): 890–895.PubMedCrossRefGoogle Scholar
  12. Fried, T.R., J. O’Leary, P. Van Ness, and L. Fraenkel. 2007. Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment. Journal of the American Geriatrics Society 55(7): 1007–1014.PubMedCrossRefGoogle Scholar
  13. Hersch, N.L., K.M. Langa, and T.J. Iwashyna. 2011. Regional variation in the association between advance directives and end-of-life Medicare expenditures. The Journal of the American Medical Association 306(13): 1447–1453.CrossRefGoogle Scholar
  14. Hickman, S.E., B.J. Hammes, A.H. Moss, and S.W. Tolle. 2005. Hope for the future: Achieving the original intent of advance directives. In Improving end of life care: Why has it been so difficult?, ed. B. Jennings, G.E. Kaebnick, and T.H. Murray, S26–S30. Garrison, NY: The Hastings Center. http://www.thehastingscenter.org/uploadedFiles/Publications/Special_Reports/improving_eol_care_why_has_it_been_so_difficult.pdf.
  15. Lingler, J.H., D. Rubin, and J.A. Saxton. 2010. Temporal stability of receptiveness to clinical research on Alzheimer disease. Alzheimer Disease and Associated Disorders 24(suppl 1): S30–S34.PubMedGoogle Scholar
  16. Martin, V.C., and K.A. Roberto. 2006. Assessing the stability of values and health care preferences of older adults: A long-term comparison. Journal of Gerontological Nursing 32(11): 23–31.PubMedGoogle Scholar
  17. McParland, E., A. Likourezos, E. Chichin, T. Castor, and B.E. Paris. 2003. Stability of preferences regarding life-sustaining treatment: A two-year prospective study of nursing home residents. The Mount Sinai Journal of Medicine 70(2): 85–92.Google Scholar
  18. Nebot, C., B. Ortega, J.J. Mira, and L. Ortiz. 2010. Dying with dignity: A study of living wills. Gaceta Sanitaria 24(6): 437–445.PubMedCrossRefGoogle Scholar
  19. Perkins, H.S. 2007. Controlling death: The false promise of advance directives. Annals of Internal Medicine 147(1): 51–57.PubMedCrossRefGoogle Scholar
  20. Pruchno, R.A., M.J. Rovine, F. Cartwright, and M. Wilson-Genderson. 2008. Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 63(2): S81–S91.CrossRefGoogle Scholar
  21. Silveira, M.J., S.Y. Kim, and K.M. Langa. 2010. Advance directives and outcomes of surrogate decision-making before death. The New England Journal of Medicine 362(13): 1211–1218.PubMedCrossRefGoogle Scholar
  22. Simón-Lorda, P., P. Domenech-Senra, L. Sánchez-Beiza, et al. 1994. Querría usted saber que tiene cáncer? MediFam: Revista de Medicina Familiar y Comunitaria 4(3): 127–136.Google Scholar
  23. Simón-Lorda, P., M.I. Tamayo-Velázquez, and I.M. Barrio-Cantalejo. 2008. Advance directives in Spain: Perspectives from a medical bioethicist approach. Bioethics 22(6): 346–354.PubMedCrossRefGoogle Scholar
  24. Smilkstein, G., C. Ashworth, and D. Montano. 1982. Validity and reliability of the family APGAR as a test of family function. The Journal of Family Practice 15(2): 303–311.PubMedGoogle Scholar
  25. Sudore, R.L., and T.R. Fried. 2010. Redefining the “planning” in advance care planning: Preparing for end-of-life decision making. Annals of Internal Medicine 153(4): 256–261.PubMedCrossRefGoogle Scholar
  26. Winter, L., S.M. Parks, and J.J. Diamond. 2010. Ask a different question, get a different answer: Why living wills are poor guides to care preferences at the end of life. Journal of Palliative Medicine 13(5): 567–572.PubMedCrossRefGoogle Scholar
  27. Wittink, M.N., K.H. Morales, L.A. Meoni, et al. 2008. Stability of preferences for end-of-life treatment after 3 years of follow-up: The Johns Hopkins Precursors Study. Archives of Internal Medicine 168(19): 2125–2130.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Ines M. Barrio-Cantalejo
    • 1
  • Pablo Simón-Lorda
    • 2
  • Adoración Molina-Ruiz
    • 3
  • Fátima Herrera-Ramos
    • 4
  • Encarnación Martínez-Cruz
    • 5
  • Rosa Maria Bailon-Gómez
    • 6
  • Antonio López-Rico
    • 4
  • Patricia Peinado Gorlat
    • 1
  1. 1.Primary Care Centre AlmanjayarGranadaSpain
  2. 2.Andalusian Public Health SchoolGranadaSpain
  3. 3.Virgen de las Nieves HospitalGranadaSpain
  4. 4.Primary Care Centre Salvador CaballeroGranadaSpain
  5. 5.Primary Care Centre ZaidinGranadaSpain
  6. 6.Primary Care Centre CartujaGranadaSpain

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