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Associations between understanding of current treatment intent, communication with healthcare providers, preferences for invasive life-sustaining interventions and decisional conflict: results from a survey of patients with advanced heart failure in Singapore
  1. Chetna Malhotra1,
  2. David Sim2,
  3. Fazlur Jaufeerally3,4,
  4. Eric A Finkelstein1
  1. 1 Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
  2. 2 National Heart Centre, Singapore
  3. 3 Singapore General Hospital, Singapore
  4. 4 Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Chetna Malhotra; chetna.malhotra{at}


Objectives To make informed choices about use of future invasive life-sustaining interventions (ILSI), patients with congestive heart failure (CHF) need to correctly understand the intent of their current treatments. However, healthcare providers may be wary of having these discussions due to fear of distressing patients. In this study, we assessed whether patients who understand their treatment intent are less willing to undergo ILSI and are indeed more psychologically distressed.

Design, participants and outcomes As part of a cross-sectional survey conducted prior to randomising patients for a trial, we asked 282 patients with advanced CHF (New York Heart Association Class III and IV) whether they believe their existing treatments would cure their heart condition, their willingness to undergo ILSI and assessed their anxiety and depression using the Hospital Anxiety and Depression Scale.

Results Approximately half of patients reported a willingness to undergo ILSI if needed. Only 22% knew that their current treatments were not curative. These patients were far less willing to undergo ILSI (OR 0.28, 95% CI 0.15 to 0.56) and were not at a greater risk of having clinically significant anxiety (OR 0.72, 0.34 to 1.54) and depression (OR 0.70, 0.33 to 1.47) compared with those who did not understand their current treatment intent.

Conclusions Improving patients’ understanding of the intent of their current treatments can help patients make informed choices about ILSI.

Trial registration number NCT02299180; Pre-results.

  • heart failure
  • advanced care planning
  • treatment intent

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors CM conceptualised the study along with DS, FJ and EAF. All authors contributed to the interpretation of data, manuscript writing and revising the manuscript for publication.

  • Funding This work was supported by Lien Centre for Palliative Care Research Award (LCPC-IN14-0001) and Health Services Research Competitive Research Grant (HSRG14may011), Ministry of Health, Singapore.

  • Competing interests None declared.

  • Patient consent Not reqiured.

  • Ethics approval SingHealth Centralised Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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