342 Vol. 43 No. 2 February 2012Schedule With Abstracts

Do Personal Preferences for Life-SustainingTherapy Influence Medical Decision MakingAmong Pediatric Intensivists? (313-C)Jennifer Needle, MD MPH, Oregon Health &Science University, Portland, OR. RichardMularski, MD MSHS MCR, Kaiser Permanente,Portland, OR. Thuan Nguyen, MD PhD, OregonHealth & Science University, Portland, OR. ErikFromme, MD MCR, Oregon Health & ScienceUniversity, Portland, OR.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Measure the personal preferences for life-

sustaining treatment among pediatricintensivists.

2. Examine the relationship between pediatricintensivists’ personal preferences for life-sus-taining treatment and medical decisionmaking.

Background.Withholding and withdrawal of life-sustaining treatments in the pediatric intensivecare unit is influenced by physiciancharacteristics.

Research objectives. To examine the relation-ship between pediatric intensivists’ personalpreferences for life-sustaining therapies andmedical decision making.

Method. Cross-sectional national anonymousmail survey of pediatric intensivists identifiedby the American Medical Association Master-file. A Personal Preference Score (PPS) was cal-culated from responses to questions ofpersonal preferences for life-sustaining treat-ments adapted from ‘‘Your Life, Your Choices,’’by Pearlman and colleagues. Physicians wereasked to consider the ‘‘acceptability’’ of treat-ment options in a hypothetical scenario ofa child with a spinal cord transection. Logisticregression controlling for socio-demographiccharacteristics computed odds ratios that rep-resent the association between finding an op-tion ‘‘acceptable’’ to a one standard deviationdecrease in the PPS (lower preference forlife-sustaining therapy).

Result. A total of 471 (30%) surveys were re-turned. Intensivists with lower PPS were signifi-cantly less likely to consider it acceptable tooffer (OR ¼ 0.64; 95% CI, 0.62-0.66; p # 0.01)and recommend (OR ¼ 0.73; 95% CI, 0.71-0.74; p # 0.01) performing a tracheostomy, lesslikely to offer (OR ¼ 0.34; 95% CI, 0.28-0.34;

p ¼ 0.02) and recommend (OR ¼ 0.53; 95%CI, 0.52-0.55; p # 0.01) reintubation if the pa-tient failed extubation, and were more likely toconsider it acceptable to offer (OR ¼ 1.58;95% CI, 1.55-1.62; p # 0.01) and recommend(OR ¼ 1.42; 95% CI, 1.39-1.46; p # 0.01) thatthe patient not be reintubated if extubationfailed and to recommend DNR status (OR1.34; 95% CI, 1.31-1.37; p ¼ <0.01).

Conclusion. Personal preferences for life-sus-taining therapy were significantly associatedwith scenario-based responses to acceptabilityof withholding/withdrawal of life-sustainingtherapies.

Implications for research, policy, or practice.Physicians should ensure that family preferencesare elicited and incorporated into medical deci-sion making.

Beyond Dying: Illness Descriptions ofPatients With Advanced Medical Illness(314-A)Deborah Morris, MD, Durham VA Medical Cen-ter and Duke University, Durham, NC. KimberlyJohnson, MD, Duke University, Durham, NC.Karen Steinhauser, PhD, Duke & VA MedicalCenter, Durham, NC.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Recognize common themes in patients’ re-

sponses to the clinical questions ‘‘What isyour understanding of your illness?’’ and‘‘What has your doctor told you about the fu-ture course of your illness?’’

2. Discuss implications of these responses forcancer and non-cancer patients.

3. Identify physician-patient communicationstrategies based on these findings that en-hance opportunities for information sharingand partnering with patients across the dis-ease trajectory.

Background. Communication guidelines stressusing open-ended questions to explore patients’perceptions of illness and prognosis. Questionslike ‘‘What is your understanding of your ill-ness?’’ are used by clinicians in breaking badnews with cancer patients or addressing codestatus at the end-of-life but have not been wellstudied in other disease groups or earlier inthe disease trajectory.

Vol. 43 No. 2 February 2012 343Schedule With Abstracts

Research objectives. Analyze responses to thequestions ‘‘What is your understanding of yourillness?’’ and ‘‘What has your doctor told youabout the future course of your illness?’’ amongadvanced cancer and non-cancer patients.

Method. Qualitative analysis of 210 patients’ re-sponses to queries of illness understanding. Re-sponses were recorded at the baseline interviewof a larger, longitudinal study of patients with ad-vanced life-limiting illness. After coding emer-gent themes, investigators conducted patternanalysis to examine variation associated with di-agnosis and demographics.

Result. 210 subjects included 70 patients withcancer, CHF, or COPD, with a mean age of 66years. Major themes identified included: nam-ing, prognosis, personal illness history, symp-toms, and causality. Patients did not emphasizemortality. Responses varied by diagnosis and ed-ucation but not illness severity. Subjects whocompleted high school more often referencedmortality and named their illness. Cancer pa-tients’ responses more often included prognosiswhile non-cancer patients referenced symptomsand causality. These differences were also re-flected in reported discussions of their futurewith their physicians.

Conclusion. Because most patients do not dis-cuss their illness in terms of mortality but insteaddescribe living with illness, these themes providepatient-centered guidance on using open-endedquestions to explore patients’ perceptions of ill-ness earlier in the disease trajectory.

Implications for research, policy, or practice.Our results require a shift from research empha-sizing illness understanding as a dichotomousmodel of awareness of dying. Studies on pa-tient-physician communication should incorpo-rate these themes to develop techniquestailored to diagnosis and education level forpartnering with patients earlier in the courseof life-limiting illness.

Reports From Ecuador on Continuing BondsWith the Deceased (314-B)Terrah Foster, PhD RN CPNP, Vanderbilt Univer-sity, Nashville, TN. Jessie Gordon, MEd CCLS,St. Jude Children’s Research Hospital, Memphis,TN. Roberto Contreras, SIFAT, Quito, Pichin-cha. Melissa Roth Vanderbilt University Schoolof Nursing, Atlanta, GA. Mary Jo Gilmer, PhD

MBA RN-BC FAAN, Vanderbilt University Schoolof Nursing, Nashville, TN.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe how bereaved individuals from un-

derserved areas of Ecuador experience con-tinuing bonds with their deceased lovedones.

2. Discuss differences and similarities betweenour results and previous research on continu-ing bonds.

3. Discuss cultural implications for future re-search and practice.

Background. Continuing bonds, or maintainingconnections with the deceased, can providecomfort and facilitate coping for bereaved chil-dren and adults. Continuing bonds have beenobserved in a variety of bereaved populations,such as parents, siblings, adult children, andpet owners. However, few studies have exam-ined continuing bonds among understudiedgeographic sites and various ethno-culturalbackgrounds, including underserved and pov-erty-stricken communities in Ecuador.

Research objectives. To examine how bereavedindividuals from underserved areas of Ecuadorexperience continuing bonds with their de-ceased loved ones.

Method. Bereaved individuals (N ¼ 51) living inunderserved areas of Ecuador were recruited. Par-ticipants included individuals ages 8 years andold-er who had experienced the death of a loved one(eg, relative) within the last year. Researchers con-ducted semi-structured interviews in Ecuador viaSpanish translators, askingopen-endedquestions.Content analysis identified emerging themes.

Result. Two major themes of continuing bondsemerged from participant responses. Participantsexperienced purposeful (eg, keeping personalbelongings/photographs, talking/praying to thedeceased, enjoying activities the deceased partici-pated inwhile alive, visiting cemetery) andnonpur-poseful (eg, dreams about deceased, visits fromdeceased) bonds. Bereaved individuals experi-enced both comforting and discomforting effectsfrom continuing bonds. Counts and frequenciesof participant responses will be presented.

Conclusion. While nearly all participants re-ported maintaining connections with the de-ceased, continuing bonds resulted in both