Objective: To determine patient characteristics associated with patient and proxy perceptions of physicians' recommendations for life-prolonging care versus comfort care, and with acceptance of such recommendations.
Design: Cross-sectional.
Setting: Five teaching hospitals in Denver, Colo.
Patients: We studied 239 hospitalized adults believed by physicians to have a high likelihood of dying within 6 months.
Measurements and main results: Interviews with patients or proxies were conducted to determine perceptions of physicians' recommended goal of care and roles in decision making.
Results: Patients' mean age was 66.6 years; 44% were women. In adjusted analysis, age greater than 70 years and female gender were associated with a higher likelihood of believing that comfort care had been recommended by the physician (odds ratio [OR], 3.70; 95% confidence interval [CI], 1.89 to 7.24; OR, 1.99; 95% CI, 1.04 to 3. 84, respectively). Patients and proxies gave substantial decision-making authority to physicians: 29% responded that physicians dominate decision making, 55% that decision making is equally shared by physicians and patients, and only 16% that patients make decisions. Increasing age was associated with an increased likelihood of believing that physicians should dominate decision making (P <.005).
Conclusions: Among patients with advanced illness, perceived comfort care recommendations were related to patient age and gender, raising concern about possible gender and age bias in physicians' recommendations. Although all patients and proxies gave significant decision-making authority to physicians, older individuals were more likely to give physicians decision-making authority, making them more vulnerable to possible physician bias.