(RxWiki News) When a patient is terminally ill, many doctors encourage high-intensity, agressive life support treatment to keep patients alive as long as possible. However, their medical opinion may differ from their personal preference.
A recent study found that most doctors would not choose to remain on life support if they were terminally ill, despite the fact that they tend to encourage life-prolonging treatment for their terminally ill patients.
The researchers discovered that doctors’ attitudes were influenced by gender, ethnicity and specialty, and have not changed significantly overall in the past 23 years.
"Discuss your preference for end-of-life care with your doctor."
The lead author of this study was Vyjeyanthi S. Periyakoil, MD, from the Stanford University School of Medicine and the Veterans Affairs Palo Alto Health Care System—both in Palo Alto, California.
The study included 1,081 doctors who graduated from clinical training programs at teaching hospitals within Stanford Hospital and Clinics and the Veterans Affairs Palo Alto Health Care System between March and July 2013.
Fifty-one percent of the doctors were female, 51 percent were white and 58 percent were between the ages of 30 and 39 years old.
The doctors collectively came from 14 different specialties, but the most popular ones were surgery (15 percent), pediatrics (13 percent), family and internal medicine (24 percent) and anesthesiology (11 percent).
Each doctor completed a web-based Advance Directive (AD) form—a document that indicates a patient’s preference for end-of-life treatment—as well as a 14-item survey on their attitudes toward AD in general.
There also was a control group of 790 doctors from Arkansas who took the same 14-item survey on AD attitudes in 1989 (but did not fill out a person AD form). All of the 1989 doctors specialized in family and internal medicine, 93 percent were male and ethnicity/race was not listed.
The researchers compared the answers of the 2013 group with those of the 1989 cohort in order to assess any changes in doctors’ attitudes towards AD since the Patient Self Determination Act, a law giving patients more control over their end-of-life care, was passed in 1990.
The findings showed that attitudes towards AD did not change significantly from 1989 to 2013 except on three items from the 14-item survey.
Compared to the 1989 doctors, the 2013 doctors:
- Felt they were more confident in making treatment decisions when guided by an AD
- Were less likely to believe that AD would encourage less aggressive treatments
- Were not as worried about the legal consequences of limiting end-of-life treatment when following an AD
The researchers discovered that 954 (88 percent) of the 2013 doctors opted to not be put on life support if they were to fall terminally ill.
The female doctors had more positive attitudes towards AD than the male doctors, and there were no differences in attitudes among the different age groups of doctors.
Race/ethnicity affected the doctors’ attitudes towards AD, with the white and African-American doctors having the most positive attitudes towards AD, followed by the Asian doctors and finally the Hispanic/Latino doctors who had the least positive attitudes towards AD.
The findings also revealed that subspecialty played a large part in the doctors’ attitudes towards AD. The doctors who specialized in emergency medicine, physical medicine and rehabilitation, pediatrics and obstetrics and gynecology were mostly in favor of AD, whereas the doctors in radiology and nuclear medicine, surgery, orthopedics and radiation oncology were the least in favor of AD.
The doctors who were less supportive of AD were more likely to want aggressive, end-of-life treatment and were less likely to be an organ donor.
Dr. Periyakoil said these findings beg the question, "Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn't choose it for ourselves?"
She argued that this lack of change in doctors’ attitudes toward AD is an example of the medical system's continued focus on aggressive treatment at the end of life, despite the fact that most Americans now say they would prefer to die at home without life-prolonging interventions.
"A big disparity exists between what Americans say they want at the end of life and the care they actually receive," the researchers noted. "More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden."
The study was limited because the 2013 doctors came from two hospitals in the same geographical location so the findings may not be generalizable to other areas, and it’s possible that the study participants’ end-of-life wishes may have changed over time.
This study was published on May 28 in PLoS Medicine.
The National Institutes of Health, Stanford University School of Medicine and the Department of Veterans Affairs provided funding.