Feb 1, 2022
This episode features Dr Catherine Auriemma (Pulmonary and
Critical Care Medicine Hospital of the University of
Pennsylvania).
Prior surveys and limited qualitative work have identified several
health states that patients value as equal to or worse than
death.
The broad range of health states consider equal to or worse than
death and the shared attributes of those states are not known.
Potential for using states worse than death as a patient-centered
outcome measure or values elicitation tool is unknown.
In this qualitative study of 29 community-dwelling, older adults
with serious illnesses, a wide range of impairments were valued as
equal to or worse than death, with the most common attributes of a
states worse than death being burdening loved ones and being
unable to maintain human connections. Patients believed
definitions of states worse than death were deeply personal and
subject to change, both with time and fluctuations in health
status. The common attributes underlying a broad range of physical,
cognitive, and social impairments viewed as states worse than death
help reveal patients’ core values and preferences for
care.
Patients identified important barriers to using avoidance of states
worse than death to guide medical decisions, limiting its
applicability as an outcome measure. Asking about states worse than
death could serve as a novel and efficient values elicitation
tool.