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O-95 Stability of willingness to accept life-sustaining treatments of patients with advanced chronic organ failure during one year
  1. Carmen HM Houben1,
  2. MA Spruit1,
  3. Jmga Schols2,
  4. EFM Wouters1,3 and
  5. Daisy JA Janssen1,4
  1. 1Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
  2. 2Department of Family Medicine and Department of Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
  3. 3Department of Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands
  4. 4Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands

Abstract

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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