Chest
Volume 127, Issue 1, January 2005, Pages 328-334
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Ethics in Cardiopulmonary Medicine
Association of Depression and Life-Sustaining Treatment Preferences in Patients With COPD

https://doi.org/10.1378/chest.127.1.328Get rights and content

Study objective

Depressive symptoms and reduced health-related quality of life are common in patients with severe COPD. Therefore, understanding the association between preferences for life-sustaining treatment and depression or quality of life is important in providing care. No prior studies have examined the effects of depression and quality of life on treatment preferences in this population.

Design and patients

Cross-sectional study of 101 patients with oxygen-prescribed COPD.

Methods

Patients completed the St. George's Respiratory Questionnaire, Center for Epidemiologic Studies–Depression survey, and questions regarding their preferences for mechanical ventilation and cardiopulmonary resuscitation if needed to sustain life.

Results

Median age was 67.4 years, and median FEV1 was 26.3% predicted. Depression was significantly associated with preferences for resuscitation (50% of depressed patients and 23% of patients without depression refused resuscitation; p = 0.007), but was not associated with preferences for mechanical ventilation. Health-related quality of life was not associated with preferences for either resuscitation or mechanical ventilation.

Conclusions

Clinicians caring for patients with oxygen-prescribed COPD should understand that health-related quality of life does not predict treatment preferences and should not influence clinicians' views of patients' treatment preferences. However, depression does appear to influence patients' treatment decisions for cardiopulmonary resuscitation, and improvement in depressive symptoms should trigger a reassessment of these preferences.

Section snippets

Recruitment and Enrollment

This study was conducted in Seattle, WA, between July 1999 and June 2002. Methods have been described previously in a report of the quality of communication about end-of-life care.20 Eligibility criteria included age > 18 years, English-speaking, diagnosis of COPD with evidence of airflow obstruction, and prescription for 24-h home oxygen. Exclusion criteria were temporary oxygen use or mental status that precluded participation. Patients were identified through ambulatory pulmonary clinics in

Results

At the two study sites where patients were contacted by clinicians familiar to the patient, 78 eligible patients were identified and 50 patients were enrolled, for a participation rate of 64%. At the two study sites where patients were sent a mailing describing participation and then telephoned by study staff, 217 eligible patients were identified and 68 patients were enrolled, for a participation rate of 31%. Overall, of the 295 eligible patients contacted and asked to participate in a 1-h

Discussion

This study of patients with oxygen-prescribed COPD resulted in three central findings. First, in univariate analysis, older age is associated with a preference against CPR and mechanical ventilation. This result extends the findings of a prior survey13 of elderly outpatients, as well as the SUPPORT study,26 to patients with oxygen-prescribed COPD. In our study, 44% of patients > 65 years old preferred not to receive either CPR or mechanical ventilation or both, a percentage similar to the 42%

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