The Stability of Treatment Preferences Among Patients With Advanced Cancer

Abstract

Context: Stability of patients' treatment preferences has important implications for decisions about concurrent and future treatment.

Objectives: To examine the stability of treatment preferences and correlates among patients with advanced cancer.

Methods: In this cohort, 104 patients with metastatic cancer, progression after at least one chemotherapy regimen, and an oncologist-estimated life expectancy of six or fewer months participated in structured interviews after clinical visits in which patients' recent scan results were discussed. Interviews were repeated in three monthly follow-ups. At baseline, patients' age, education, sex, race, marital status, insurance status, and type of cancer were documented. At each assessment, patients reported their treatment preferences (i.e., prioritizing life-prolonging vs. comfort), quality of life, and current health status.

Results: At baseline (n = 104), 55 (53%) patients preferred life-prolonging care and 49 (47%) preferred comfort care. Patients were followed up for one (n = 104), two (n = 74), or three months (n = 44). Between baseline and Month 1, 84 patients (81%) had stable preferences. During follow-up, preferences of 71 patients (68%) remained stable (equally divided between a consistent preference for life-prolonging and comfort care). Treatment preferences of 33 (32%) patients changed at least once during follow-up. Direction of change was inconsistent. Patients' preferences at baseline strongly predicted preferences at Month 1 (odds ratio = 17.8; confidence interval = 6.7-47.3; P < .001). Description of the current health status at baseline was the only variable significantly associated with stability of preferences at Month 1.

Conclusion: Two-thirds of patients with advanced cancer had stable preferences. Changes of preferences were often inconsistent and unpredictable. Our findings suggest potential benefits of ongoing communication about preferences.

Keywords: Cancer; advance care planning; decision-making; patient care planning; patient preference.

Conflict of interest statement

DISCLOSURES

The authors declare that there are no competing interests.

Copyright © 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Flow Diagram of Patients.

Figure 2a.. Preferences over Time, Beginning with Comfort Care.

Abbreviations: CC=preference for comfort care; LP=preference for life-prolonging care; drop-out CC=stable preferences for comfort care until drop-out

Figure 2b.. Preferences over Time, Beginning with Life-Prolonging Care.

Abbreviations: CC=preference for comfort care; LP=preference for life-prolonging care; drop-out LP=stable preferences for life-prolonging care until drop-out