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Association of Depression and Life-Sustaining Treatment Preferences in Patients With COPD^*

^* From the Division of Pulmonary and Critical Care Medicine (Drs. Stapleton, Nielsen, Engelberg, and Curtis), Department of Medicine, School of Medicine; and Program in Social and Behavioral Sciences (Dr. Patrick), Department of Health Services, School of Public Health, University of Washington, Seattle, WA.

Correspondence to: Renee D. Stapleton, MD, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, 325 Ninth Ave, Seattle, WA 98104-2499; e-mail: rstaplet{at}u.washington.edu

Study objective: Depressive symptoms and reduced health-related quality of life are common in patients with severe COPD. Therefore, understanding the association between preferences for life-sustaining treatment and depression or quality of life is important in providing care. No prior studies have examined the effects of depression and quality of life on treatment preferences in this population.

Design and patients: Cross-sectional study of 101 patients with oxygen-prescribed COPD.

Methods: Patients completed the St. George’s Respiratory Questionnaire, Center for Epidemiologic Studies–Depression survey, and questions regarding their preferences for mechanical ventilation and cardiopulmonary resuscitation if needed to sustain life.

Results: Median age was 67.4 years, and median FEV₁ was 26.3% predicted. Depression was significantly associated with preferences for resuscitation (50% of depressed patients and 23% of patients without depression refused resuscitation; p = 0.007), but was not associated with preferences for mechanical ventilation. Health-related quality of life was not associated with preferences for either resuscitation or mechanical ventilation.

Conclusions: Clinicians caring for patients with oxygen-prescribed COPD should understand that health-related quality of life does not predict treatment preferences and should not influence clinicians’ views of patients’ treatment preferences. However, depression does appear to influence patients’ treatment decisions for cardiopulmonary resuscitation, and improvement in depressive symptoms should trigger a reassessment of these preferences.

Key Words: COPD • depression • end of life • quality of life • treatment preferences

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