Evidence map›Paper›PMID 29212487›Full record

ArticleBMC medical informatics and decision making2017

Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices.

Michelle Howard, Nick Bansback, Amy Tan, Doug Klein, Carrie Bernard, Doris Barwich, Peter Dodek, Aman Nijjar, Daren K Heyland

Abstract read
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In one paragraph

Article in BMC medical informatics and decision making, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Michelle HowardDepartment of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada. mhoward@mcmaster.ca.ORCID http://orcid.org/0000-0001-8127-5492
Nick BansbackSchool of Public and Population Health at the University of British Columbia, Vancouver, BC, Canada.
Amy TanDepartment of Family Medicine, University of Calgary, Calgary, Alberta, Canada.
Doug KleinDepartment of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
Carrie BernardDepartment of Family and Community Medicine, University of Toronto, Toronto, Canada.
Doris BarwichDivision of Palliative Care, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Peter DodekCentre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
Aman NijjarGeneral Internal Medicine, Faculty of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Daren K HeylandDepartment of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.

Funding

Canadian Frailty Network which is supported by the Government of Canada through the Networks of Centres of Excellence program CORE2013-13Ontario Ministry of Health and Long-Term Care 06687
6 · The paper itself

Abstract

backgroundDecisions about care options and the use of life-sustaining treatments should be informed by a person's values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient's expressed treatment preference.

methodsWe conducted a multi-site survey in 20 family practices. Patients aged 50 and older self-completed a questionnaire assessing the importance of eight values (rated 1 to 10), and indicated their preference for use of life-sustaining treatment (5 options). We compared correlations among values to a priori hypotheses based on whether the value related to prolonging or shortening life, and examined expected relationships between importance of values and the preference option for life-sustaining treatment.

resultsEight hundred ten patients participated (92% response rate). Of 24 a priori predicted correlations among values statements, 14 were statistically significant but nearly all were negligible in their magnitude and some were in the opposite direction than expected. For example, the correlation between importance of being comfortable and suffering as little as possible and the importance of living as long as possible should have been inversely correlated but was positively correlated (r = 0.08, p = 0.03). Correlations between importance of values items and preference were negligible, ranging from 0.03 to 0.13.

conclusionsPatients may not recognize that trade-offs in what is most important may be needed when considering the use of treatments. In the context of preparation for decision-making during serious illness, decision aids that highlight these trade-offs and connect values to preferences more directly may be more helpful than those that do not.

Indexed as

AgedAged, 80 and overFamily PracticeFemaleHealth Care SurveysHumansMaleMiddle AgedPatient PreferenceTerminal Care

Identifiers

PMID29212487
PMCPMC5719577

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.