Abstract
BackgroundDecisions about care options and the use of life-sustaining treatments should be informed by a person’s values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient’s expressed treatment preference.MethodsWe conducted a multi-site survey in 20 family practices. Patients aged 50 and older self-completed a questionnaire assessing the importance of eight values (rated 1 to 10), and indicated their preference for use of life-sustaining treatment (5 options). We compared correlations among values to a priori hypotheses based on whether the value related to prolonging or shortening life, and examined expected relationships between importance of values and the preference option for life-sustaining treatment.ResultsEight hundred ten patients participated (92% response rate). Of 24 a priori predicted correlations among values statements, 14 were statistically significant but nearly all were negligible in their magnitude and some were in the opposite direction than expected. For example, the correlation between importance of being comfortable and suffering as little as possible and the importance of living as long as possible should have been inversely correlated but was positively correlated (r = 0.08, p = 0.03). Correlations between importance of values items and preference were negligible, ranging from 0.03 to 0.13.ConclusionsPatients may not recognize that trade-offs in what is most important may be needed when considering the use of treatments. In the context of preparation for decision-making during serious illness, decision aids that highlight these trade-offs and connect values to preferences more directly may be more helpful than those that do not.
Highlights
Decisions about care options and the use of life-sustaining treatments should be informed by a person’s values and treatment preferences
Most people who are approaching the end of life have a point after which they shift their preferences from a treatment and cure orientation and express a preference for non
The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient’s expressed treatment preference, to understand whether and how these values statements could be useful in guiding deliberations with health care providers about use of lifesustaining treatments
Summary
Decisions about care options and the use of life-sustaining treatments should be informed by a person’s values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient’s expressed treatment preference. When people are faced with the need to make decisions about health care during serious illness or near the endof-life, they may not be adequately prepared. Most people who are approaching the end of life have a point after which they shift their preferences from a treatment and cure orientation and express a preference for non-. The consideration and communication of values and preferences in preparation for future decisions made by patients or their substitute decision-makers in consultation with health care providers, are key aspects of ACP [13]. Advance directives have limited utility because they contain instructions that may not apply to the specific situation of the patient when the decision is needed [14] and they do not have legal standing in some jurisdictions
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