Patients' willingness to accept risks of medical intervention: intubation and ventilatory support for short periods of time

Abstract

Study objective: To assess patients' willingness to accept the risks of intubation and ventilatory support (IVS) for short periods of time.

Design: Cross-sectional structured interviews of patients.

Setting: The Department of Veterans Affairs Medical Center, Portland, Oregon, USA, a university-based Department of Veterans Affairs Medical Center.

Participants: 97 consecutive patients (mean age =67.4 years, s.d. =9.16, range =39–84) seen for continuity clinic appointments in a general medicine clinic.

Measurements and Results: In a hypothetical situation of an acute exacerbation of a medical condition requiring IVS, patients were asked whether they would accept IVS if their physician thought that their acute exacerbation was reversible (defined as being able to leave the hospital with their mental capacity minimally affected and being able to care for themselves in most activities of daily living in a nursing home environment). Patients were also asked to define what they meant by a “short period of time of IVS,” and at what chance of reversal of their acute exacerbation they would allow their physicians to act with IVS (measured by means of a lottery methodology). Ninety-seven percent (94/97) of patients reported a willingness to undergo IVS for a short period of time. Eighteen percent reported that they would allow IVS for 1–2 days; 38% reported 3–14 days; 14% reported 15–30 days; and 30% reported >30 days. One third of the patients were willing to accept IVS if the probability of reversal were ≤40%. Patients with advance directives preferred to be supported for fewer days on IVS than patients without an advance directive (P=0.014).

Conclusions: We conclude that most patients are willing to allow IVS for the reversal of an acute condition as defined above. There are wide variations in the length of time patients would allow IVS and in the probability of reversal they would require before their physician intervened with IVS on their behalf. These results suggest that discussions about advance directives with patients should include assessment of patient preferences about duration of intervention and probability of successful outcome.