This application, titled """"""""End-of-Life Decision Making About Medical Treatments,"""""""" concerns people's preferences for medical interventions in foreseeable but not-yet-experienced health scenarios. Submitted to AHRQ as a small grant application in response to PA #PAR-01-040, it pertains to the topics of """"""""enhancing informed decision-making in primary care setting"""""""" and """"""""improving care at the end of life."""""""" The application will extend a program of research that applies an important model, prospect theory, to the domain of end-of-life decision-making. Prospect theory posits that an individual's current health serves as the reference point from which hypothetical states of health are viewed: More remote prospects appear indistinguishable from each other, while closer prospects are easily distinguished. In two preliminary studies conducted by the principal investigator, frail (or low functioning) elders expressed preferences for more years of life under worse prospective health conditions than did healthier elders. The proposed study's primary aim is to test the hypothesis that preferences for life-sustaining treatments (of varying invasiveness) are influenced by the patient's current health status: People in poor health will view invasive interventions as more acceptable in worse medical scenarios than will those who are healthy at the time of decision-making. In the proposed cross-sectional study, 300 elderly, cognitively intact people 60+ years of age, white and African American, in diverse health conditions, will be recruited through several sources. In a 30-minute interview conducted on the telephone, they will answer questions concerning preferences for four medical treatments under each of eight medical scenarios; current physical health and functioning; mood; religiosity; and demographic characteristics. Cognitive status will be assessed using a telephone-based dementia screen. Prospect theory predictions are that, when contemplating future health prospects, currently healthy people will opt for fewer invasive treatments under the worse health scenarios than will currently sick people. As current health deteriorates, prospective invasive treatments will be viewed as more tolerable. The hypothesis will be evaluated using a repeated-measures analysis of covariance. The proposed study will serve as a first step toward an R01 application examining two additional questions: 1) A longitudinal study will test whether preferences for years of desired life and invasive medical treatments change as an individual's health and functioning deteriorates. 2) An intervention study will examine whether altering the description of advance-directive-style options (i.e., providing a description of palliative care vs. treatment) may influence preferences for treatments under various medical scenarios. By illuminating the decision-making processes underlying advance directives, study results should enhance communication between health providers and patients and provide guidance for the construction and timing of advance directives.
| Winter, Laraine; Moss, Miriam S; Hoffman, Christine (2009) Affective forecasting and advance care planning: anticipating quality of life in future health statuses. J Health Psychol 14:447-56 |
