Study to Understand Prognoses & Preferences for Outcomes & Risks of Treatment (SUPPORT)

Conclusions: 1) physicians & surrogates are often unaware of preference of seriously ill patients 2) care provided to critically ill patient often NOT consistent with their wishes 3) physicians understood 86% of patients preferences for CPR but only 46% of patient's preferences to forgo it 4) among patients with preferences to forgo CPR, physicians believed that 54% of them wished to receive CPR 5) prognosis for patients with congestive heart failure is difficult, complicating palliative care planning for these patients Findings: 1) patients with congestive heart failure: a) no significant change in quality of life during last 6 months b) median predicted life expectancy was 6 months, even within 3 days of death 2) patients with terminal cancer (lung or colon) a) often show terminal decline in quality of life several weeks prior to death b) older patients with cancer used less resources than younger patients & were less likely to receive chemotherapy during the 1st week of hospitalization c) length of stay & total hospital costs were less for older & middle-age cancer patients than younger patients d) older cancer patients were no more likely to be discharged with supportive tests, including hospice e) 50% of patients died within 6 months of hospital discharge f) few patients were discharged with supportive care g) patients increasingly preferred comfort care as they approached death h) many patients died in severe pain Also see Support prognostic model.

References

1Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004