End-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs

doi:10.1378/chest.117.5.1474

Chest

Volume 117, Issue 5, May 2000, Pages 1474-1481

https://doi.org/10.1378/chest.117.5.1474 Get rights and content

Study objectives

The study assessed the interests of ambulatory cardiac patients in advance planning and their willingness to participate in rehabilitation program-based end-of-life education. Design: Observational survey study.

Setting

Fourteen outpatient cardiac rehabilitation programs in 11 states.

Participants

Four hundred fifteen subjects enrolled in cardiac rehabilitation.

Measurements and results

A questionnaire determined patient preferences for advance planning, completion of advance directives, completion of patient-physician discussions on end-of-life care, and effects of health status on patient acceptance of life-sustaining interventions. Seventy-two percent of patients wanted to direct their own end-of-life care, 86% desired more information on advance directives, 62% wanted to learn about life-sustaining care, and 96% were receptive to advance-planning discussions with their physicians. Seventy-two percent of patients had considered that they might require life-sustaining care in the future; acceptability of resuscitative care depended on health status and probability of survival. However, only 15% had discussed advance planning with their physicians, and 10% were confident that their physicians understood their end-of-life wishes. Physicians and cardiovascular rehabilitation programs were considered desirable sources of information on advance planning.

Conclusions

Cardiac patients enrolled in rehabilitation programs want to learn more about end-of-life care and need more opportunities to discuss advance planning with their physicians. Patients consider cardiovascular rehabilitation programs to be acceptable sites for advance planning education.

Section snippets

Materials and Methods

This study surveyed patients enrolled in cardiovascular rehabilitation programs anytime during the period of November 1996 to February 1998. Invitations to participate in the research project were mailed to the 1,013 cardiovascular rehabilitation programs listed in the 1996 roster published by the American Association of Cardiovascular and Pulmonary Rehabilitation (Middleton, WI). A random sample of 48 of the 450 interested responding programs stratified to the four quadrants of the continental

Study Subjects

Questionnaires were received from 415 of the 450 participants (92%) enrolled in 14 hospital-based cardiac rehabilitation centers in 11 states. The centers were located in the following states: AZ (1 center), CT (1 center), IL (3 centers), IN (1 center), MN (1 center), NB (1 center), OH (2 centers), SC (1 center), TX (1 center), WA (1 center), and WI (1 center). The mean number of patients drawn from each center was 29 ± 18. One of the centers, which enrolled 15 study patients, presented

Discussion

This study demonstrates that patients enrolled in cardiovascular rehabilitation programs want to learn about advance planning and life-supportive care, and to make their own decisions about end-of-life care. Most of the surveyed patients considered they might someday require cardiopulmonary resuscitation, and 90% had formulated opinions on the desirability of resuscitative care. Almost all (> 95%) of the surveyed patients were interested in having advance care planning discussions with their

ACKNOWLEDGMENT

The authors thank the following program directors for their participation in the study: Julie Jackson, RN, St. Joseph's Hospital and Medical Center, Phoenix, AZ; Deena McCarthy, RN, Middlesex Hospital, Middletown, CT; Grace Sechman-Noettl, BSN, RNC, Ravenswood Hospital, Chicago, IL; Char Martin, RN, MS, Alexian Brothers Medical Center, Elk Grove Village, IL; Shari Schultz, RN, Illini Hospital, Silvis, IL; Rosemary Wasielewski, MSN, RNC, Munster Community Hospital, Munster, IN; Judy Hurst, RN,

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Citation Excerpt :
The potential impact of AD on utilization of cardiac-specific resources, such as ventricular assist devices, intra-aortic balloon pumps, and cardiac rhythm management devices, has not been well studied. When asked specifically, most patients with serious cardiovascular disease and no AD wanted more information about AD, similar to the general population6 and the 86% of patients in the cardiac rehabilitation study (both with and without AD) who indicated interest in discussing AD.10 This finding differs markedly from the ONC patients, very few of whom indicated an interest in AD.
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Patients admitted to a cardiac care unit (CCU) were surveyed regarding demographics, medical history, prevalence of AD, and interest in obtaining more information about AD. Histories of life-threatening cardiac diagnoses were tabulated. Prevalence of AD and interest in obtaining more information about AD were obtained via chart review from patients on an oncology (ONC) floor at the same hospital.
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Chest

Ethics in Cardiopulmonary MedicineEnd-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs

Study objectives

Setting

Participants

Measurements and results

Conclusions

Section snippets

Materials and Methods

Study Subjects

Discussion

ACKNOWLEDGMENT

Advance directives for medical care: a case for greater use

N Engl J Med

Outpatients' attitudes regarding advance directives

J Fam Pract

Patient acceptance of an information sheet about cardiopulmonary resuscitation options

J Gen Intern Med

Cardiopulmonary resuscitation: how useful? Attitudes and knowledge of an elderly population

Arch Intern Med

Attitudes regarding advance directives among patients in pulmonary rehabilitation

Am J Respir Crit Care Med

Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT Project

Circulation

Outcomes of advance directive education of pulmonary rehabilitation patients

Am J Respir Crit Care Med

Involvement of cardiovascular rehabilitation programs in advance directive education

Arch Intern Med

JMP statistical package

Advance directives and the elderly: a study of interventional strategies to increase their use

Gerontologist

Ethics in Cardiopulmonary Medicine
End-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs