“End-of-life Care Preferences in Patients with Severe and Persistent Mental Illness and Chronic Medical Conditions: A Comparative Cross-sectional Study”

Project Summary:

Objectives: Physicians rarely engage severe and persistent mental illness (SPMI) patients in end-of-life care discussion despite an increased risk of debilitating medical illnesses and mortality. Whereas access to quality palliative care and medical assistance in dying (MAID) has become a priority in Canada and many jurisdictions, we 1) compared SPMI and chronic medically-ill (CMI) patients’ end-of-life care preferences and comfort level about end-of-life care discussion, and 2) identified potential predictors of interest in MAID.

Design: Comparative cross-sectional study.

Setting: Hospital-based.

Participants: We recruited 106 SPMI and 95 CMI patients at the Jewish General Hospital, Canada. Patients aged ≥40 years, without severe cognitive impairment, able to communicate in English or French, and able to provide written informed consent were included.

Measurements: Attitudes towards pain management, palliative sedation, MAID, and artificial life support were collected with the Health Care Preferences Questionnaire. Adjusted odd ratios were calculated for each end-of-life care intervention. Comfort with discussion was rated on a Likert scale. A step-wise regression analysis was performed to identify predictors of interest in MAID.

Results: SPMI was not correlated to any end-of-life care intervention, except for MAID where SPMI patients were less likely to support its use (aOR=0.48, CI 95% 0.25-0.94). Religiosity was also correlated with interest in MAID (aOR=0.14, CI 95% 0.06-0.31). 85% of patients in both groups were comfortable talking about end-of-life care.

Conclusions: Our findings show that SPMI patients are able to voice their end-of-life care preferences, and contrary to some fears, do not want MAID more than CMI patients.

Keywords: End-of-life Care, Severe and Persistent Mental Illness, Medically Ill, Medical Assistance in Dying

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