Observational studyJournal of the American Geriatrics Society2025
Patterns of Life-Sustaining Treatment Preferences Among Seriously Ill Veterans.
Observational study in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
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Who cites it
1 citing paper in PubMed.
- Patterns of Life-Sustaining Treatment Preferences Among Seriously Ill Veterans.Journal of the American Geriatrics Society · 2025Observational
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundGoals of care conversations and documentation of life-sustaining treatment (LST) preferences through durable, portable medical orders are critical for aligning care with patient values. The stability of patient preferences over time remains uncertain, particularly among community-dwelling adults. The Department of Veterans Affairs Life-Sustaining Treatment Decisions Initiative provides a unique opportunity to examine preference trajectories among seriously ill Veterans using longitudinal real-world data. This analysis aimed to: identify cardiopulmonary resuscitation (CPR) preference trajectories, describe Veterans' characteristics by trajectory, and examine associations between trajectories and demographic/clinical factors.
methodsThis longitudinal observational analysis used VA Corporate Data Warehouse data to identify the population of Veterans with completed LST templates as of October 1, 2019 (N = 161,725). CPR preference (full code or do-not-resuscitate [DNR]) over 39 months was analyzed for stability using sequence analysis, and CPR preference trajectories were identified. Veterans' characteristics were compared across trajectories, and multinomial logistic regression was used to assess associations with trajectory membership.
resultsFour CPR preference trajectories were identified: (1) persistent preference for DNR (39.8%), (2) code status fluctuation with early mortality (8.7%), (3) code status fluctuation with later mortality (7.3%), and (4) persistent preference for full code (44.3%). Older Veterans were more likely to persist in DNR preferences, while younger Veterans were in full code. Veterans having higher baseline comorbidities, chronic conditions such as heart failure, and higher hospitalization rates were at greater risk of having fluctuating preferences. Those with dementia had a greater likelihood of persistent DNR.
conclusionsThis analysis provides critical insights into the complexity of CPR preference trajectories among Veterans, highlighting the need for nuanced, patient-centered approaches to advance care planning. By addressing dynamic clinical factors, leveraging hospitalizations as strategic opportunities, and incorporating culturally sensitive communication, healthcare providers can improve the alignment of treatment preferences with patients' evolving goals and values.
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