Patients More Open to Treatment Side Effects as Disease Progresses

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Faced with declining health due to a chronic illness, many patients become more willing to accept treatments that could leave them functionally disabled, a new study finds.

In fact, patients may be more willing to accept these treatments than the general public or doctors believe—even when therapies reduce their quality of life, are risky or have little chance of benefiting their condition.

“Peoples’ viewpoints do change over time,” said Elizabeth Chaitin, the director of medical ethics/palliative care services at the University of Pittsburgh Medical Center. “As people age and become disabled, they are more willing to accept what we might see as a bad quality of life—they don’t see it as a bad quality of life.”

Chaitin was not involved with the study, which was led by Dr. Terri R. Fried of the Veterans Administration Connecticut Healthcare System and Yale University School of Medicine. Her team published its findings in the April 24 Archives of Internal Medicine.

People who suffer from long-term, debilitating illnesses are often faced with tough choices—not only does their illness affect their quality of life, but doctors often present them with treatment options that come with debilitating side effects. Prolonged stays in the hospital or intensive-care unit, becoming dependent on respirators, and potent chemotherapies can all take a heavy toll on quality of life.

Some of these treatment-linked disabilities include troubles with mobility—for example, difficulties in walking, getting dressed or bathing. Certain therapies may bring added pain or even trouble with mental function.

But how willing are patients to accept these consequences of treatment?

In its study, Fried’s team interviewed 226 older adults with advanced chronic illnesses. Thirty-five percent had cancer, 36 percent had chronic obstructive pulmonary disease (COPD) and 29 percent suffered from heart failure.

The patients were interviewed every four months for up to two years. They were asked if they would accept treatment for their condition if the treatment resulted in mild physical disability, severe physical disability, cognitive impairment or pain.

As the patients’ health declined, they became more likely to accept mild to even severe physical disability as outcomes of treatment, the study found.

Over the course of the study, 19 percent changed their views on mild disability to from “unacceptable” to “acceptable,” as did 20 percent when it came to severe physical disability. Patients who had declining functional abilities were more likely to rate physical disability as acceptable as their functioning became worse.

Just six percent of patients changed their feelings about mild and severe physical disability from “acceptable” to “unacceptable,” the researchers said.

Seventy-five percent of the patients rated declines in cognitive ability as unacceptable, and the chance of rating cognitive impairment as acceptable decreased over time. In addition, 37 percent rated pain as unacceptable, but patients who already suffered moderate to severe pain were more likely to rate pain as acceptable.

Chaitlin thinks doctors should not be too quick to judge what is an “acceptable” quality of life. Instead, she said, they should take their cue from the patient’s preference, which will likely change over time.

“People do adapt over time,” she said. “Physicians have to constantly ask people as their lives change how they are feeling about their living situation and whether they are happy in the situation they are in.”

Health-care providers should not make quick or rash judgments about how people live their lives, Chaitin said. “It’s amazing to me what you can tolerate as a human being and what conditions you can be in and find to be acceptable,” she said.

SOURCES: Elizabeth Chaitin, M.S.W., director, medical ethics/palliative care services, University of Pittsburgh Medical Center; April 24, 2006, Archives of Internal Medicine

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