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Context Changes Choices: A Prospective Study of the Effects of Hospitalization on Life-Sustaining Treatment Preferences

Author

Listed:
  • Peter H. Ditto

    (Department of Psychology & Social Behavior, 3340 Social Ecology II, University of California, Irvine, Irvine, CA 92697-7085; phditto@uci.edu)

  • Jill A. Jacobson

    (Department of Psychology, Queen's University)

  • William D. Smucker

    (Department of Family Practice, Summa Health System)

  • Joseph H. Danks

    (Center for Advanced Study of Language, University of Maryland)

  • Angela Fagerlin

    (VA Center for Practice Management and Outcomes Research, University of Michigan)

Abstract

Objective .Policy and law encouraging individuals to document their wishes for life-sustaining medical treatment in advance of serious illness assumes that these wishes are unaffected by changes in health condition. To test this assumption, the authors examine the life-sustaining treatment preferences of a sample of elderly adults prior to, soon after, and several months after a hospitalization experience. Subjects and Methods. As part of the Advance Directives, Values Assessment, and Communication Enhancement (ADVANCE) project, 401 individuals older than age 65 participated in 3 annual interviews. A subsample of 88 individuals who were hospitalized for greater than 48 hours during the course of the study participated in an additional “recovery†interview conducted soon after their release from the hospital (M = 14 days postdischarge). At each interview, subjects indicated their desire to receive 4 life-sustaining medical treatments in 4 serious illness scenarios. Results . Treatment preferences showed a significant “hospitalization dip,†with subjects reporting less desire to receive life-sustaining treatment at the recovery interview than they did at the annual interview conducted prior to hospitalization, but with desire returning to near prehospitalization levels at the annual interview conducted several months after hospitalization. This dip was more pronounced in preferences for cardiopulmonary resuscitation and artificial nutrition and hydration than in preferences for less invasive treatments. Conclusions . Preferences for life-sustaining treatment are dependent on the context in which they are made, and thus individuals may express different treatment preferences when they are healthy than when they are ill. These results challenge a key psychological assumption underlying the use of instructional advance directives in end-of-life decision making.

Suggested Citation

  • Peter H. Ditto & Jill A. Jacobson & William D. Smucker & Joseph H. Danks & Angela Fagerlin, 2006. "Context Changes Choices: A Prospective Study of the Effects of Hospitalization on Life-Sustaining Treatment Preferences," Medical Decision Making, , vol. 26(4), pages 313-322, July.
    • Handle: RePEc:sae:medema:v:26:y:2006:i:4:p:313-322
    DOI: 10.1177/0272989X06290494
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    Cited by:

    1. Hsin-Lung Chan & In-Fun Li & Ling-Chun Tseng & Yvonne Hsiung, 2020. "Exploring Behavioral Readiness and Program Strategies to Engage Older Community Residents in Advance Care Planning: A Pilot Mixed-Method Study in Taiwan," IJERPH, MDPI, vol. 17(12), pages 1-20, June.
    2. Thomas, Elizabeth C. & Bass, Sarah Bauerle & Siminoff, Laura A., 2021. "Beyond rationality: Expanding the practice of shared decision making in modern medicine," Social Science & Medicine, Elsevier, vol. 277(C).

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