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Stability and Change in Patient Preferences and Spouse Substituted Judgments Regarding Dialysis Continuation

¹ New Jersey Institute for Successful Aging, University of Medicine & Dentistry of New Jersey, Stratford.
² Department of Human Development and Family Studies, Pennsylvania State University, University Park.

Correspondence concerning this article should be addressed to Rachel Pruchno, PhD, New Jersey Institute for Successful Aging, University of Medicine & Dentistry of New Jersey, 42 East Laurel Rd., Suite 2300, Stratford, NJ 08084. E-mail: pruchnra{at}umdnj.edu

Objectives. The objective of this study was to examine whether some treatment preferences are more stable than others, how patient preferences and substituted judgments change over time, and whether some people's decisions are more stable than others'.

Methods. Hypothetical scenarios elicited preferences for dialysis continuation under various health conditions at two points in time. Predictors included initial treatment preference, age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health.

Results. Some treatment preferences were more stable than others, and the cause of this stability varied across treatment preferences. Similarity between patient preferences and spouse substituted judgments within couples was low and varied as a function of hypothetical condition. The strongest predictor of treatment preferences at follow-up was initial preference. Age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health had limited effects on changes to treatment preferences.

Discussion. There is a great deal more stability than change in patient preferences and substituted judgments regarding continuation of dialysis over the course of 1 year. This suggests that if patients have previously expressed preferences it is possible for this to maintain their voice in end-of-life decisions when the patients themselves are unable to express their wishes.

Key Words: Dialysis • Patient preferences