Quality of Life and Recommendations for Further Care.

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2016-11

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Abstract

OBJECTIVES: Physician recommendations for further medical treatment or palliative treatment only at the end of life may influence patient decisions. Little is known about the patient characteristics that affect physician-assessed quality of life or how such assessments are related to subsequent recommendations. DESIGN, SETTING, AND SUBJECTS: A 2010 mailed survey of practicing U.S. physicians (1,156/1,878 or 62% of eligible physicians responded). MEASUREMENTS AND MAIN RESULTS: Measures included an end of life vignette with five experimentally varied patient characteristics: setting, alimentation, pain, cognition, and communication. Physicians rated vignette patient quality of life on a scale from 0 to 100 and indicated whether they would recommend continuing full medical treatment or palliative treatment only. Cognitive deficits and alimentation had the greatest impacts on recommendations for further care, but pain and communication were also significant (all p < 0.001). Physicians who recommended continuing full medical treatment rated quality of life three times higher than those recommending palliative treatment only (40.41 vs 12.19; p < 0.01). Religious physicians were more likely to assess quality of life higher and to recommend full medical treatment. CONCLUSIONS: Physician judgments about quality of life are highly correlated with recommendations for further care. Patients and family members might consider these biases when negotiating medical decisions.

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10.1097/CCM.0000000000001846

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Putman, Michael S, Hyo Jung Tak, Farr A Curlin and John D Yoon (2016). Quality of Life and Recommendations for Further Care. Crit Care Med, 44(11). pp. 1996–2002. 10.1097/CCM.0000000000001846 Retrieved from https://hdl.handle.net/10161/14619.

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Scholars@Duke

Curlin

Farr A Curlin

Professor of Medicine

Farr Curlin, MD, is Josiah Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities, & History of Medicine and Co-Director of the Theology, Medicine and Culture Initiative (TMC) at Duke University. Dr. Curlin has worked to bring attention to the intersection of medicine, ethics, and theology. In 2012 he helped to found both the University of Chicago’s Program on Medicine and Religion and the annual Conference on Medicine and Religion. Since 2015, through Duke Divinity School’s TMC Initiative, he and colleagues have brought graduate theological training to those with vocations to health care. Starting in 2023, Dr. Curlin also is working with colleagues across North America to develop the Hippocratic Society, an association of students and practitioners dedicated to fulfilling the profession to heal. He is co-author, with Chris Tollefsen, of The Way of Medicine: Ethics and the Healing Profession (Notre Dame University Press, 2021), as well as more than 150 articles and book chapters addressing the moral and spiritual dimensions of medical practice.


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