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Research Letter |

States Worse Than Death Among Hospitalized Patients With Serious Illnesses ONLINE FIRST

Emily B. Rubin, MD, JD1,2; Anna E. Buehler, BS2; Scott D. Halpern, MD, PhD1,2,3,4
[+] Author Affiliations
1Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, Philadelphia
2Fostering Improvement in End-of-Life Decision Science Program, University of Pennsylvania, Philadelphia
3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
4Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Intern Med. Published online August 01, 2016. doi:10.1001/jamainternmed.2016.4362
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This cohort study examines how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death.

Cohort studies and randomized trials among hospitalized patients with acute and serious illnesses commonly use mortality as the primary or key secondary outcome measure. Death is a patient-centered outcome because nearly everyone wishes to avoid it. Despite this general preference, however, studies among healthy outpatients and those with serious illnesses show that a significant minority, and sometimes a majority, rate states such as severe dementia as worse than death.13

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Ratings of States of Functional Debility Relative to Death by Hospitalized Patients With Serious Illnesses

Distribution of patient ratings of each queried health state on a 5-point Likert scale.

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