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Research Letter
October 2016

States Worse Than Death Among Hospitalized Patients With Serious Illnesses

Author Affiliations
  • 1Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia
  • 2Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, Philadelphia
  • 3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
  • 4Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Intern Med. 2016;176(10):1557-1559. doi:10.1001/jamainternmed.2016.4362

Cohort studies and randomized trials among hospitalized patients with acute and serious illnesses commonly use mortality as the primary or key secondary outcome measure. Death is a patient-centered outcome because nearly everyone wishes to avoid it. Despite this general preference, however, studies among healthy outpatients and those with serious illnesses show that a significant minority, and sometimes a majority, rate states such as severe dementia as worse than death.13

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