Stability of Patient Preferences Regarding Life-Sustaining Treatments: DISCUSSION part 2

In regard to our second study question, we found no significant differences in the life-sustaining treat­ment preferences, including preferences about dura­tion of treatments expressed by ICU patients at the time of transfer from the ICU compared to those expressed by the same patients one month later when no longer in the ICU nor under the stress of an acute illness. These results suggest that patient preferences regarding life-sustaining treatments are stable over one month despite changes in health and mood. Two
studies of cancer patients’ preferences obtained similar results. One study found that cancer patient prefer­ences for treatment did not change significantly when measured before and then six months following treat­ment despite significant treatment toxicity. Another study of patients with laryngeal cancer showed stabil­ity of values regarding voice expressed before and after treatment despite changes in clinical state. In contrast, women’s preferences about anesthesia during childbirth changed significantly during labor when compared to those expressed before and after labor. Our results may be more consistent with those found in the studies of cancer patient preferences because of similarities in the two populations. Our study patients, like the cancer patients, are older, have more chronic disease and are confronting choices about life- sustaining treatments and not about treatment of a symptom during a limited situation such as childbirth.

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Stability of Patient Preferences Regarding Life-Sustaining Treatments: DISCUSSION

In this study we explored two questions: (1) what are the life-sustaining treatment preferences of criti­cally ill ICU patients; and (2) are these preferences stable over a one-month period. In regard to the first question, ICU patients expressed a diversity of life-sustaining treatment preferences. Preferences re­garding one treatment did not generalize to other treatments. Furthermore, preferences regarding a particular life-sustaining treatment often changed un­der the markedly different clinical conditions pre­sented in the three scenarios. These findings suggest that patient preferences are difficult to predict. We already know that patient preferences do not appear to be strongly correlated with demographic character­istics or health status measures. Thus, it is not surprising that physicians are inaccurate in predicting patient preferences.

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Stability of Patient Preferences Regarding Life-Sustaining Treatments: RESULTS part 2

Stability Patient

Fifty-three percent of the ICU patients had previ­ously discussed their preferences about life-prolonging treatments with another person. However, only 10 percent of patients reported communicating their views to a physician. Forty-three percent of married patients had talked with their spouse about their preferences for life-sustaining therapies.

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Stability of Patient Preferences Regarding Life-Sustaining Treatments: RESULTS

The age of our study participants was 64 ± 9 years. Most patients were white (90 percent), cognitively intact (90 percent by the Short Pbrtable Mental Status questionnaire criteria), and had at least a high school education (59 percent). Other patient characteristics are presented in Table 1.

Percentages of patients favoring each life-sustaining treatment in the three scenarios are shown in Table 2. Most patients desired resuscitation in the current health situation and hospitalization for the treatment of pneumonia in the stroke and dementia scenarios. Fewer patients wanted the other treatments. Larger percentages of patients favored therapies in the cur­rent health situation than in the other scenarios.

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Stability of Patient Preferences Regarding Life-Sustaining Treatments: METHODS

We interviewed Seattle Veterans Administration Medical Center patients sampled from intensive care units from October to Decem­ber 1987. All interview and questionnaire content was approved by the University of Washington Human Subjects Review Committee. Informed consent was obtained from willing patients.

Subjects

Consecutive patients who had survived a medical intensive care unit or coronary care unit stay of at least 48 hours were recruited for participation. Entry criteria also included male gender, age greater than 50 years, English speaking, and ability to provide informed consent and complete the interview. Patients transferred to a surgical service were excluded from participation.

During the study period, 80 patients survived an ICU stay of at least 48 hours and were transferred out of the ICU. Forty-six of these patients did not meet the other study criteria: 25 were under 50 years of age; seven were women; seven were unable to complete the questionnaire; five were transferred to a surgical service; and two were previously interviewed. Thirty-four patients met the study criteria and were asked to participate. Thirty (88 percent) agreed.

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Stability of Patient Preferences Regarding Life-Sustaining Treatments

Life-Sustaining Treatments

The unconditional use of medical interventions such as cardiopulmonary resuscitation and mechanical ventilation has prompted numerous discussions about the appropriate definitions and indications for life- sustaining treatments. Decisions regarding life-sus­taining treatments are traditionally based on medical indications. However, patients increasingly desire con­sideration of their attitudes about medical therapies in health care decisions. Furthermore, patients are empowered by law to accept or refuse medical rec­ommendations, including those regarding life-sustain­ing treatments.

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Stability of Trisodium Citrate and Gentamicin Solution: DISCUSSION

hemodialysis

The HPLC methods used for analysis of gentamicin and citrate proved acceptable, and for both methods the validation studies indicated suitable linearity over an acceptable range, as well as suitable accuracy and precision. The specificity of the methods was established by means of forced degradation, and the peaks for the degradation products all had retention times well separated from those of the analytes. There were no changes in peak symmetry or retention times for parent compounds over the validation period. The presence of citrate was shown to not interfere with the analysis of gentamicin, and the presence of gentamicin was shown to not interfere with the analysis of citrate.

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