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December 13, 1995

Nursing Home Residents' Preferences for Life-Sustaining Treatments

Author Affiliations

From the Center for Clinical Epidemiology and Biostatistics, Division of General Internal Medicine, School of Medicine (Ms O'Brien, Dr Grisso, Mr Maislin, and Ms LaPann), and the School of Nursing (Dr Evans), University of Pennsylvania, Philadelphia; the Institute for Survey Research, Temple University, Philadelphia, Pa (Dr Krotki); the School of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr Greco); and the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden (Dr Siegert).

JAMA. 1995;274(22):1775-1779. doi:10.1001/jama.1995.03530220041030

Objectives.  —To determine life-sustaining treatment preferences among nursing home residents, whether information regarding cardiopulmonary resuscitation (CPR) affected these preferences, and with whom treatment preferences had been discussed, and to identify factors associated with CPR preferences.

Design.  —In-person survey.

Setting.  —Forty-nine randomly selected nursing homes.

Subjects.  —Four hundred twenty-one randomly selected nursing home residents capable of making decisions.

Main Outcome Measures.  —Preferences regarding CPR, hospitalization, and enteral tube feedings, and individual factors associated with CPR preferences.

Results.  —Of 1458 randomly selected nursing home residents assessed for the ability to participate in the study, 552 residents (38%) were eligible to participate and 421 agreed to be interviewed. Sixty percent of participants able to participate in the decision reported that they would elect CPR, 89% would choose hospitalization if seriously ill, and 33% would elect enteral tube feedings if no longer able to eat because of permanent brain damage. Individual factors associated with preferences for CPR included the following: African-American ethnicity, high self-reported physical mobility, belief that most important medical care decisions should be made by the doctor, moderate-to-severe impairment in daily decision-making skills, and not having a spouse. Fourteen percent changed their preference from preferring CPR to not preferring CPR after receiving additional information about CPR procedures. Twelve percent reported having discussed preferences with health care providers, and 31% discussed preferences with family members.

Conclusions.  —More than half of nursing home residents capable of making decisions preferred the use of CPR. Few had discussed their preferences with health care providers. Individual preferences should be assessed when considering the use of life-sustaining treatments.(JAMA. 1995;274:1775-1779)