END-OF-LIFE CARE: Resuscitation Wishes Often Misjudged
"Doctors often misjudge whether patients with congestive heart failure want to be resuscitated if their hearts stop beating," according to a new study published in the journal Circulation. USA Today reports that the study found that doctors were wrong about their patients' end-of-life wishes about a quarter of the time. Doctors primarily erred in believing patients wanted to be resuscitated when in fact they did not. "The paper highlights the importance of trying to improve patient-doctor communication," said lead author Dr. Harlan Krumholz, a cardiologist at Yale University School of Medicine (Rubin, 8/18). In the study, researchers questioned 936 patients who were hospitalized for congestive heart failure between 1989 and 1994. They found that 23% of the patients said they did not want to be resuscitated, 69% did and 8% were unsure. Patients who were most likely to reject resuscitation thought "they would live less than two months" and were characterized as "older, wealthier and less able to take care of their own basic needs."
The study also questioned doctors of 750 of the patients about what they believed the patients' wishes were. In nearly one out of every four of these cases, the doctors were wrong -- most of the time when the patient did not want to be resuscitated. Doctor who said they would not choose resuscitation if they were in the patient's position were the most likely to predict their patients' preferences correctly. The older a patient, the more likely his or her doctor incorrectly guessed their wishes. Oddly enough, "even physicians who had discussed resuscitation preferences with their patients were found to be no more accurate in predicting patients' wishes than those who had not" (release, 8/17).
Change Of Heart
Krumholz said doctors should initiate the dialogue about end-of-life wishes with their patients. "We don't want to extinguish people's hope, but we want to help them prepare for the possibility they may not survive long," he said (USA Today, 8/18). However, the study also interviewed patients two months after they left the hospital, and found that 19% of them had changed their minds about resuscitation. In fact, 40% of the patients who had "earlier rejected resuscitation" had a change of heart, most likely because congestive heart failure patients often feel substantially better between bouts of hospitalization. "This may explain why we see far more patients wanting resuscitation -- when their symptoms fade for a while, they are able to regain their hope of surviving," said Krumholz (release, 8/17).