• Susan L Mitchell, Jennifer A Palmer, Angelo E Volandes, Laura C Hanson, Daniel Habtemariam, and Michele L Shaffer.
• Hebrew SeniorLife, Institute for Aging Research, Boston, Massachusetts, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. Electronic address: smitchell@hsl.harvard.edu.
• J Pain Symptom Manage. 2017 Sep 1; 54 (3): 340345340-345.

ContextDelivering goal-directed care is a hallmark of high-quality palliative care, but requires an understanding of preferences.ObjectivesTo describe and identify factors associated with level of care preferences among proxies of nursing home (NH) residents with advanced dementia.MethodsNH residents with advanced dementia and their proxies (N = 402 dyads) were recruited from 62 Boston-area facilities as part of an ongoing randomized clinical trial. At baseline, all proxies were asked to select which level of care they felt the resident should receive: intensive, basic, or comfort care. Multivariable logistic regression identified resident and proxy factors associated with a preference for comfort care (vs. basic or intensive medical care).ResultsProxy level of care preferences were: comfort, 62.2%; basic, 31.1%; and intensive medical care, 6.5%. In multivariable analyses, proxy perception that the resident had less than six months to live was most strongly associated with a preference for comfort-focused care (adjusted odds ratio 12.25, 95% CI 4.04-37.08). Additional factors significantly associated with a preference for comfort care included older resident age, worse resident cognitive impairment, and the proxy having been asked about goals of care preferences by a NH health care provider (adjusted odds ratio 1.71, 95% CI 1.07, 2.74).ConclusionMost proxies select comfort as the preferred level of care for NH residents with advanced dementia. Discussions regarding prognosis, as well as inquiry about goals of care, are modifiable factors that may promote a preference for comfort care in this population.Copyright © 2017. Published by Elsevier Inc.

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