End-of-life treatment preferences of persons with serious mental illness

Objective: The goal of this study was to ascertain preferences for end-of-life care among persons with serious mental illness. Methods: The participants were 150 community-residing adults with serious mental illness. The Health Care Preferences Questionnaire was administered to obtain information about treatment preferences in response to hypothetical medical illness scenarios: use of pain medication in the case of incurable cancer and use of artificial life support in the case of irreversible coma. Participants were asked what their treatment preferences would be for an imaginary person in each scenario ("other") as well as their preferences for themselves ("self"). Results: For the scenario involving pain medication for incurable cancer, most participants chose aggressive pain management even if cognition might be affected ( 64 percent of respondents under the "other" scenario and 66 percent under the "self" scenario). Few participants thought a doctor should provide patients with enough medication to end their life ( 34 percent for self and 24 percent for other). For the scenario involving irreversible coma, respondents were divided in their choice regarding life support. Approximately one-quarter said that they would prefer to immediately terminate life support ( 28 percent of respondents for other and 29 percent for self), and half said they would choose to turn it off after a defined period ( 48 percent for other and 45 percent for self). Conclusions: Persons with serious mental illness were able to designate treatment preferences in response to end-of-life health state scenarios. Future research is needed to test advance care planning methods, assess stability of choices over time, and ascertain the utility of scenario-based preferences to guide end-of-life care decisions in this population.