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ICU patients are more likely to receive the care they prefer if they discuss it with their doctor

Many Americans fear spending their last days of life in an intensive care unit (ICU) attached to "life saving" machinery. Seriously ill ICU patients who prefer palliative or comfort care to extraordinary life saving measures are twice as likely to get that care if they discuss their care preferences with their doctors. Yet only one-third of seriously ill ICU patients do so, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08158).

For example, 45 percent of ICU patients at five medical centers preferred an approach to care that focused on extending life, even if it meant having more pain, and 36 percent wanted their medical care to focus on their comfort, even if it shortened their life. Among those who wanted life-extending support, 88 percent said they obtained it, 2 percent said current care was aimed at comfort, and 10 percent did not know what the current approach to their medical care was.

Among those who preferred palliative care, only 29 percent said they obtained it, 47 percent said care was contrary to their preferences, and 24 percent did not know what the current approach to their medical care was. Patients who discussed their preferences for palliative care with a physician were nearly twice as likely as other patients to believe that their treatment was palliative. Yet few patients discussed their treatment preferences with their doctors. Based on interviews conducted during the second week of hospitalization, only 38 percent of patients (or their surrogates) reported that their physicians had talked with them about their prognoses, and only 34 percent said they had talked to their doctors about their preferred approach to care.

Improved communication between patients and health care providers is needed so that patients receive care that is tailored to meet their goals and preferences, concludes Joan M. Teno, M.D., M.S., of Brown University. Dr. Teno and her colleagues evaluated the decisionmaking and outcomes of 1,494 seriously ill patients who stayed in one of five ICUs for at least 14 days (median stay 35 days) and were enrolled in a larger treatment outcomes study. The researchers interviewed patients, surrogate decisionmakers, and physicians about prognosis, communication, and goals of medical care.

See "Decision-making and outcomes of prolonged ICU stays in seriously ill patients," by Dr. Teno, Elliot Fisher, M.D., M.P.H., Mary Beth Hamel, M.D., M.P.H., and others, in the May 2000 Journal of the American Geriatrics Society 48, S70-S74.

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