Discussions about limiting treatment in a geriatric clinic.

Objective: Obtain detailed information about the frequency and content of discussions about withholding treatment between doctors and elderly outpatients.
Design: Survey.
Setting: Primary care geriatric clinic at an urban university.
Participants: Twelve physicians and one nurse practitioner completed questionnaires for 185/198 (93.4%) patient visits.
Measurements: Questionnaires were completed by physicians after each patient visit during August 1989. Interviews were conducted with physicians who had discussed limiting life-sustaining treatment with patients.
Results: Ten percent (n = 19) of patients seen had had discussions with their physicians about life-sustaining treatment. These patients were older and had worse prognoses as estimated by their physicians. Physicians usually raised the issue with the families of demented patients and mentioned dementia, quality of life, prognosis, and the need to make other clinical decisions as motivation for initiating discussions. The majority of patients with poor prognoses, however, had not had discussions about life support.
Conclusions: Despite increasing attention given to end-of-life decisions in the medical and lay press, discussions with elderly outpatients about limiting treatment occur rarely. They are more likely when patients are older or have worse prognoses, but age, prognosis, and poor quality of life do not consistently lead physicians to raise the issue.