Medical treatment preferences in nursing home residents.

Abstract

To the Editor: Thanks go to Gerety et al1 for an excellent study on medical treatment preferences in nursing home residents. They show a larger number of residents than previously reported2-5 indicating that they wanted CPR or a ventilator in their current health state. This may have something to do with the way the scenarios were presented. Treatment descriptions are important in influencing choices made by elderly persons creating advanced directives.6 While the descriptions of the treatments appeared to be excellent, one is left with an empty feeling on reading the descriptions of “no treatment,” a phrase that might feed the fears of being left alone as well as fears of pain common among dying elderly patients.7 For example, the study states, “The alternative to mechanical ventilation was described as certain death.” A more positive, but realistic, statement would be, “The alternative to mechanical ventilation would be giving you medicines and oxygen as needed to make sure you were comfortable, realizing that you would ultimately die.” With this description, the number of patients choosing to forgo mechanical ventilation would likely be much higher. That would also probably be the case if the results of the initial survey were reviewed with the patient by their personal physician, with an opportunity for questions and further explanation.