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December 26, 2002


Emory Physicians Study Patients' Preferences Regarding End of Life Care

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."

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