• Houben Carmen H M CHM Department of Research and Education, CIRO, Horn, The Netherlands. Electronic address: carmenhouben@ciro-horn.nl., Martijn A Spruit, Schols Jos M G A JMGA Department of Family Medicine and Department of Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht Universit, Wouters Emiel F M EFM Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands., and Janssen Daisy J A DJA Department of Research and Education, CIRO, Horn, The Netherlands; Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherl.
• Department of Research and Education, CIRO, Horn, The Netherlands. Electronic address: carmenhouben@ciro-horn.nl.
• Chest. 2017 May 1; 151 (5): 1081-1087.

BackgroundFor optimal end-of-life decision-making, it is important to understand the stability of patients' treatment preferences. The aim of this paper is to examine the stability of willingness to accept life-sustaining treatments during 1-year follow-up in Dutch patients with advanced chronic organ failure. In addition, we want to explore the association between willingness to accept high-burden treatment and preferences for CPR and mechanical ventilation (MV).MethodsIn this multicenter longitudinal study, 265 clinically stable outpatients with advanced COPD (Global Initiative for Chronic Obstructive Lung Disease stage III/IV [n = 105]), chronic heart failure (New York Heart Association class III/IV [n = 80]), or chronic renal failure (requiring dialysis [n = 80) were visited at baseline and at 4, 8, and 12 months to assess the stability of life-sustaining treatment preferences using the Willingness to Accept Life-sustaining Treatment instrument.ResultsTwo hundred six patients completed 1-year follow-up (mean age, 67.2 years [SD, 13.1 years]; 64.1% men). Overall, proportions of patients who were willing to accept life-sustaining treatment during 1 year did not change over time. However, individual trajectories showed that about two-thirds of patients changed their preferences at least once during a year. Moreover, there was no association found between the stability of willingness to undergo high-burden therapy and the stability of preferences for CPR and MV.ConclusionsThe current findings show the complexity of preferences for end-of-life care and indicate once again that advance care planning is a continuous process between patients and physicians, in which preferences for specific situations are discussed and that needs to be regularly reevaluated to deliver high-quality end-of-life care.Clinical Trial RegistrationNetherlands National Trial Register (NTR 1552).Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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