Emory Physicians Study Patients' Preferences Regarding End of Life
For many individuals, facing death is a daunting reality. Discussing
oneís preferences about end-of-life care while in good health is therefore
all the more important. At Grady Memorial Hospital, Alexia Torke, MD,
assistant professor at the Emory University School of Medicine, William
Branch, MD, Carter Smith Senior Professor at Emory University School
of Medicine and Division Director of General Medicine at Grady, and
William Sexson, MD, associate dean for clinical affairs and chair of
the Grady Ethics Committee, recently spearheaded a research study exploring
hospitalized patientsí thoughts and preferences about end-of-life care.
"The idea behind the project
is that we as doctors often have ideas about how to take care of patients
at the end of life, but we donít ask the patients directly," Dr. Torke
explained. "Research studies looking at patient preferences are usually
conducted with patients who are either mostly white or from private
hospital settings. So, we donít know a lot about what the people who
come to Grady would like for care at the end of life. What we were trying
to figure out is what our African-American patients want as they approach
the end of life."
For example, in a study published
by the Journal of the American Medical Association in 1995 regarding
end-of-life care, more than 75 percent of the subjects were white, most
had a high school education or more, and only 5 percent were uninsured.
The patients interviewed
in the current study at Grady were not at the end stages of life, Dr.
Torke pointed out. Yet because many had serious illnesses, Dr. Torke
believed they were at the point when end-of-life care planning becomes
an important issue.
"Our goal was really to get
an in-depth idea of patientsí feelings and thoughts about the kinds
of things they would want from doctors and the medical team when they
got to the end of life," Dr. Torke said. "Some people might want aggressive
medical care up to the end, but others feel that they donít want a lot
of aggressive medical care. They want to be kept comfortable and to
die at home with friends and family. The purpose of this research was
to find out what our patients at Grady prefer."
Dr. Torke and her team asked
subjects questions about what kind of care they would want at the end
of life and whether they had expressed their preferences to anyone else,
either through conversation with a family member or physician, or with
an advance directive, a document in which an individual gives instructions
about his or her health care if, in the future, they cannot speak for
themselves. There are two kinds of advance directives: A living will
allows individuals to specify what they want should they ever go in
a coma or a persistent vegetative state; the durable power of attorney
for healthcare allows individuals to specify a decision maker if they
are unable to make decisions for themselves.
"It becomes more and more
critical to have an advance directive as a person develops a more life-threatening
illness," Dr. Torke said. Everyone should think about these issues while
theyíre healthy and are doing well."
The study was funded through
an Emory Medical Care Foundation grant.
Research was based on qualitative
analysis, which relies on an in-depth interviewing process with a small
number of patients. The interviews were purposely open-ended to allow
patients to offer their perspectives on what they deemed most important
regarding end-of-life care.
"Physicians should consider
initiating the conversation early because often times, by the time patients
are seriously ill in the hospital, itís too late to find out what they
want," Dr. Torke said. "We need to do this while theyíre stable and
are doing well."