Background For optimal end-of-life decision-making, it is important to understand the stability of patients’ treatment preferences.
Aim To examine willingness to accept life-sustaining treatments during one year follow-up in patients with advanced chronic organ failure.
Methods In this multicenter, longitudinal study 265 clinically stable outpatients with advanced COPD (GOLD-stage III/IV, n = 105), chronic heart failure (NYHA-class III/IV, n = 80), or chronic renal failure (requiring dialysis, n = 80) were visited at baseline, 4, 8 and 12 months to assess stability of life-sustaining treatment preferences using the Willingness to Accept Life-sustaining Treatment (WALT) instrument.
Results 206 patients completed one-year follow-up (77.7%; mean age 67.2 (13.1) years; 64.1% male). Willingness to undergo low-burden therapy decreased for 23.8%, increased for 11.2%, and 29.1% reported a variable preference during one year. Willingness to undergo high-burden therapy decreased for 21.4%, increased for 14.3%, and 32.7% reported a variable preference during one year. Willingness to risk severe functional impairment as a result of low-burden therapy decreased for 20.4%, increased for 18.9%, and 35.7% reported a variable preference during one year. Willingness to risk severe cognitive impairment as a result of low-burden therapy decreased for 19.4%, increased for 12.3%, and 32.1% reported a variable preference during one year.
Discussion Regular evaluation of treatment preferences is important to deliver end-of-life care in concordance with patients’ preferences.
Conclusion The majority of patients change their preferences regarding life-sustaining treatment during one year.
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