Treatment Preferences at the End-of-Life in Parkinson's Disease Patients

Background Few studies have been performed on palliative care in Parkinson's disease (PD). This study was undertaken to understand treatment preferences of PD patients toward end-of-life care. Methods A questionnaire modified from the Willingness to Accept Life-Sustaining Treatment instrument was administered to participants. Four different scenarios based on the burden of care and outcome of the treatment were presented in detail to obtain decisions for end-of-life care. The responses in each scenario were compared between PD patients and controls. Further analyses were performed to identify factors that influenced treatment preferences among PD patients. Results In total, 136 PD patients and 60 controls were recruited. Parkinson's disease patients and controls were demographically similar, except that PD patients had more previous hospital admissions (P = 0.0195). Parkinson's disease patients were more likely to opt for high-burden care with poor outcome than controls (odds ratio [OR] = 2.11, P = 0.04). In the subgroup analysis for PD patients, the factors that influenced treatment preference toward end-of-life care were belief in religion (OR: 7.43, 95% confidence interval:1.97–28.07), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (2.51, 1.14–5.50) in scenario B; belief in religion (6.93, 2.23–21.43), married patients (6.93, 2.23–21.43) in scenario C; and Chinese patients (0.29, 0.10–0.79), better PD knowledge (0.37, 0.17–0.80), and higher UPDRS motor scores (3.05, 1.35–6.9) in scenario D. Conclusion Parkinson's disease patients were more likely to agree to high-burden care with a poor outcome compared to controls. Among PD patients, race, marital status, religious status, knowledge about PD, and severity of motor impairment significantly influenced their end-of-life treatment preferences.