Clinical study
Attitudes of hospitalized patients toward life support: A survey of 200 medical inpatients

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Abstract

purpose: Life-support decisions have profound medical, ethical, and economic implications; yet little is know about inpatients' preferences for life-sustaining treatments. We therefore conducted a prospective survey of medical inpatients to determine attitudes toward life support under differing medical outcomes, and the extent of physician communication about these issues.

patients and methods: The study population consisted of 200 adult patients admitted to the general medical services at UCLA Medical Center during August and September 1987. Each patient completed a standardized 13-item questionnaire. Patients rated their agreement with life-support treatment in the conctext of four outcome scenarios. A five-point Lickert scale for each question was used, and an overall life-support scale was created by summing the four items. Patients were also asked about previous life-support discussions with their physicians.

results: Life support was desired in 90 percent of the patients if their health could be restored to its usual level, in 30 percent if they would be unable to care for themselves after discharge, in 16 percent if their chance for recovery was hopeless, and in only 6 percent if they would remain in a vegetative state. Patients who desired less aggressive care were older, female, and more likely to have terminal illnesses. Only 16 percent reported having discussed life support with their physicians; however, and additional 47 percent desired such discussions.

conclusion: Hospitalized medical patients base their preferences for life support upon perceived outcomes. Lack of communication creats the potential for patients to be subjected to burdensome and expensive treatments they may not desire. We encourage physicians to offer their patients discussions about prognosis and the efficacy of life support so that disproportionate treatments can be avoided.

References (16)

  • DL Jackson et al.

    Patient autonomy and death with dignity—some clinical caveats

    N Engl J Med

    (1979)
  • SH Miles et al.

    The do-not-resuscitate order in a teaching hospital

    Ann Intern Med

    (1982)
  • JE Ruark et al.

    Initiating and withdrawing life support

    N Engl J Med

    (1988)
  • SE Bedell et al.

    Choices about cardiopulmonary resuscitation in the hospital—when do physicians talk with patients?

    N Engl J Med

    (1984)
  • B Lo et al.

    Patient attitudes to discussing life sustaining treatment

    Arch Intern Med

    (1986)
  • RH Shmerling et al.

    Discussing cardiopulmonary resuscitation: a study of elderly outpatients

    J Gen Intern Med

    (1988)
  • A Wagner

    Cardiopulmonary resuscitation in the aged: a prospective survey

    N Engle J Med

    (1984)
  • R Steinbrook et al.

    Preferences of homosexual men with AIDS for life-sustaining treatment

    N Engl J Med

    (1986)
There are more references available in the full text version of this article.

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A portion of this work was presented in abstract form at the American College of Physicians meeting, La Jolla, California, March 20, 1988.

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