Most patients receiving maintenance dialysis say they would prefer a comfort-based rather than a life-prolongation approach to care if they became seriously ill, the results of a recent survey suggest.

Regardless of their health care values, however, most patients did not document their treatment preferences or engage in other aspects of advance care planning, according to investigators.

The study included 933 patients, of whom 452 (48.4%) indicated they would value comfort-focused care and 179 (19.2%) longevity-focused care if they became seriously ill. The remaining 302 patients (32.4%) said they were unsure about the intensity of care they would value.


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An estimated 47.5% of those who valued comfort-focused care and 28.1% of those who preferred longevity-focused care or were unsure indicated that they had completed an advance directive, Susan P.Y. Wong, MD, MS, of the University of Washington in Seattle, and colleagues reported in JAMA Internal Medicine. In addition, 28.6% of the comfort-focused group compared with 18.2% of the longevity-focused or unsure groups discussed hospice.

The proportion of patients indicating they had documented a surrogate decision-maker was significantly higher in the comfort-focused group compared with the longevity-focused or unsure groups (52.3% vs 45.4%).

Among patients who died during follow-up, 23.5% of the comfort-focused patients and 26.1% of the longevity-focused patients or those who were unsure received an intensive procedure during the final month of life.

The authors concluded that “differences in how patients responded to the question about values did not translate into substantial differences in their engagement in advance care planning for the care they received at the end of life. These findings likely reflect the challenges to effective advance care planning and the presence of strong health system defaults favoring longevity-focused over comfort-focused care among members of this population.”

Compared with patients who preferred life prolongation, those who preferred comfort-based care were older (mean age 66 vs 59 years) and less likely to be Black (41.6% vs 58.4%).

Reference

Wong SPY, Prince DK, Tamura MK, et al. Value placed on comfort vs life prolongation among patients treated with maintenance dialysis. JAMA Intern Med. Published online March 27, 2023. doi:10.1001/jamainternmed.2023.0265