The frequency with which DNR orders were written for hospitalized patients also increased as death approached. As death approached, patients were more likely to prefer Do Not Resuscitate (DNR) status, with the percent of patients preferring DNR rising from 33% at 6 months to 3 months before death to 47% at 1 month to 3 days before death (P <. Perceived quality of life did not change appreciably, with 29 to 58 % of patients reporting good to excellent quality of life in all intervals before death. Number of functional impairments, median depression scores and percent of patients reporting severe pain or dyspnea increased as death approached, with 41% of patient surrogates reporting that the patient was in severe pain and 63% reporting that the patient was severely short of breath during the 3 days before death.
However, the median model-based estimate of 6-month survival was 54% even within 3 days of death.
Median Acute Physiology Scores for hospitalized patients rose from 33 in the interval 6 months to 3 months before death, to 44 within 3 days of death. Outcomes examined over time included: percentage of days spent in a hospital model-based prognostic estimates of 6-month survival functional status occurrence of severe physical and emotional symptoms, including pain, depression and anxiety patients' preferences for care and the financial impact of patients' illnesses on their families.Īs death approached, patients' prognoses became poorer and illnesses more severe. We describe frequency distributions for each outcome over time and report tests for trend. For each outcome, patients contributed information to all windows for which they had data collected. To describe progression to death, we constructed four observational windows backward in time, beginning with patients' dates of death and ending with their date of entry into the SUPPORT project or 6 months before death, whichever came first. To characterize the experiences of patients with congestive heart failure (CHF) during their last 6 months of life.Ī retrospective analysis of data from a prospective cohort study.įive geographically diverse tertiary care academic medical centers.Ī total of 1404 patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) with a diagnosis of an acute exacerbation of CHF, of whom 539 patients died within 1 year of their index hospitalization.ĭata from interviews with patients or their surrogates were collected and chart abstractions performed at several time points in SUPPORT.
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