Associations between understanding of current treatment intent, communication with healthcare providers, preferences for invasive life-sustaining interventions and decisional conflict: results from a survey of patients with advanced heart failure in Singapore.

Journal Article (Journal Article)


To make informed choices about use of future invasive life-sustaining interventions (ILSI), patients with congestive heart failure (CHF) need to correctly understand the intent of their current treatments. However, healthcare providers may be wary of having these discussions due to fear of distressing patients. In this study, we assessed whether patients who understand their treatment intent are less willing to undergo ILSI and are indeed more psychologically distressed.

Design, participants and outcomes

As part of a cross-sectional survey conducted prior to randomising patients for a trial, we asked 282 patients with advanced CHF (New York Heart Association Class III and IV) whether they believe their existing treatments would cure their heart condition, their willingness to undergo ILSI and assessed their anxiety and depression using the Hospital Anxiety and Depression Scale.


Approximately half of patients reported a willingness to undergo ILSI if needed. Only 22% knew that their current treatments were not curative. These patients were far less willing to undergo ILSI (OR 0.28, 95% CI 0.15 to 0.56) and were not at a greater risk of having clinically significant anxiety (OR 0.72, 0.34 to 1.54) and depression (OR 0.70, 0.33 to 1.47) compared with those who did not understand their current treatment intent.


Improving patients' understanding of the intent of their current treatments can help patients make informed choices about ILSI.

Trial registration number

NCT02299180; Pre-results.

Full Text

Duke Authors

Cited Authors

  • Malhotra, C; Sim, D; Jaufeerally, F; Finkelstein, EA

Published Date

  • September 19, 2018

Published In

Volume / Issue

  • 8 / 9

Start / End Page

  • e021688 -

PubMed ID

  • 30232107

Pubmed Central ID

  • PMC6150135

Electronic International Standard Serial Number (EISSN)

  • 2044-6055

International Standard Serial Number (ISSN)

  • 2044-6055

Digital Object Identifier (DOI)

  • 10.1136/bmjopen-2018-021688


  • eng