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End-of-life care preferences in patients with severe and persistent mental illness and chronic medical conditions : a comparative cross-sectional study
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OBJECTIVES: Physicians rarely engage severe and persistent mental illness (SPMI) patients in end-of-life care discussion despite an increased risk of debilitating medical illnesses and mortality. Access to quality palliative care and medical assistance in dying (MAID) has become a priority in Canada and many jurisdictions. In this study, we compared SPMI and chronic medically ill (CMI) patients' end-of-life care preferences and comfort level with end-of-life care discussion, and identified potential predictors of interest in MAID.
DESIGN: Comparative cross-sectional study.
SETTING: Hospital-based.
PARTICIPANTS: We recruited 106 SPMI and 95 CMI patients at the Jewish General Hospital, Canada. Patients aged =40 years, without severe cognitive impairment, able to communicate in English or French and provide written informed consent were included.
MEASUREMENTS: Attitudes towards pain management, palliative sedation, MAID, and artificial life support were collected with the Health Care Preferences Questionnaire. Adjusted odd ratios (aOR) were calculated for each end-of-life care intervention. Comfort with discussion was rated on a Likert scale. A stepwise regression analysis was performed to identify predictors of interest in MAID.
RESULTS: SPMI was not correlated to any end-of-life care intervention, except for MAID where SPMI patients were less likely to support its use (aOR: 0.48, 95% CI: 0.25-0.94, p = 0.03). Religiosity was also correlated with interest in MAID (aOR: 0.14, 95% CI: 0.06-0.31, p < 0.001). Patients in both groups were comfortable talking about end-of-life care.
CONCLUSIONS: SPMI patients are able to voice their end-of-life care preferences, and contrary to some fears, do not want MAID more than CMI patients.
Voir la revue «The American journal of geriatric psychiatry, 26»
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