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End-of-Life Care Preferences of Patients Enrolled in Cardiovascular Rehabilitation Programs^*

^* From the Department of Medicine, Medical University of South Carolina, Charleston, SC.

Correspondence to: John E. Heffner, MD, FCCP, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 812, Charleston, SC 29425; e-mail: heffnerj{at}musc.edu

Study objectives: The study assessed the interests of ambulatory cardiac patients in advance planning and their willingness to participate in rehabilitation program-based end-of-life education. Design: Observational survey study.

Setting: Fourteen outpatient cardiac rehabilitation programs in 11 states.

Participants: Four hundred fifteen subjects enrolled in cardiac rehabilitation.

Measurements and results: A questionnaire determined patient preferences for advance planning, completion of advance directives, completion of patient-physician discussions on end-of-life care, and effects of health status on patient acceptance of life-sustaining interventions. Seventy-two percent of patients wanted to direct their own end-of-life care, 86% desired more information on advance directives, 62% wanted to learn about life-sustaining care, and 96% were receptive to advance-planning discussions with their physicians. Seventy-two percent of patients had considered that they might require life-sustaining care in the future; acceptability of resuscitative care depended on health status and probability of survival. However, only 15% had discussed advance planning with their physicians, and 10% were confident that their physicians understood their end-of-life wishes. Physicians and cardiovascular rehabilitation programs were considered desirable sources of information on advance planning.

Conclusions: Cardiac patients enrolled in rehabilitation programs want to learn more about end-of-life care and need more opportunities to discuss advance planning with their physicians. Patients consider cardiovascular rehabilitation programs to be acceptable sites for advance planning education.

Key Words: advance directives • coronary disease • ethics • patient education • resuscitation decisions

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