Study to Understand Prognoses & Preferences for Outcomes & Risks of Treatment (SUPPORT)

Introduction

Conclusions:

• physicians & surrogates are often unaware of preference of seriously ill patients
• care provided to critically ill patient often NOT consistent with their wishes
• physicians understood 86% of patients preferences for CPR but only 46% of patient's preferences to forgo it
• among patients with preferences to forgo CPR, physicians believed that 54% of them wished to receive CPR
• prognosis for patients with congestive heart failure is difficult, complicating palliative care planning for these patients

Findings:

• patients with congestive heart failure:
  • no significant change in quality of life during last 6 months
  • median predicted life expectancy was 6 months, even within 3 days of death
• patients with terminal cancer (lung or colon)
  • often show terminal decline in quality of life several weeks prior to death
  • older patients with cancer used less resources than younger patients & were less likely to receive chemotherapy during the 1st week of hospitalization
  • length of stay & total hospital costs were less for older & middle-age cancer patients than younger patients
  • older cancer patients were no more likely to be discharged with supportive tests, including hospice
  • 50% of patients died within 6 months of hospital discharge
  • few patients were discharged with supportive care
  • patients increasingly preferred comfort care as they approached death
  • many patients died in severe pain

Also see Support prognostic model.

Additional terms

• SUPPORT prognostic model