Picture: An older man 
Older patients might have
different goals of care than
their physicians; © SXC

“Physicians need to offer treatment alternatives that better fit their patients’ goals and preferences,” said first author Marc Rothman, M.D., postdoctoral fellow in geriatrics in the Department of Internal Medicine at Yale.

The study explored the treatment preferences of 226 persons age 60 and older with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease. Researchers found that 16 percent of these patients reported refusing one or more medical or surgical interventions recommended by their physician.

The most frequently refused interventions were cardiac catheterization and surgery, with refusal rates of over ten percent. Other interventions refused included chemotherapy, radiation, intubation, dialysis, and transplantation. Hospitalization was rarely refused.

The most common reasons given for treatment refusals were fear of side effects. Patients who refused treatments were more likely to have congestive heart failure, to rate their own longevity at less than two years, and to want their physicians to discuss their prognosis with them. The mortality rate among those who had refused treatments was higher than those who had not.

“Our study highlights the frequency with which older persons with advanced illness refuse treatments recommended by their physicians,” said Rothman. “This frequency of refusal suggests that physicians may be recommending treatments for these patients that pose unacceptable burdens or that fail to meet patients’ goals. Patients with advanced illness may require a broader range of treatment alternatives, so that they can select the option that best meets their goals of care.”

MEDICA.de; Source: Yale University