When Terminal Illness Is Worse Than Death: A Multicenter Study of Health-Care Providers’ Resuscitation Desires


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Abstract

Purpose:To investigate how a terminal illness may affect the health-care providers’ resuscitation preferences.Methods:We conducted a cross-sectional survey in 9 health-care institutions located in 4 geographical regions in North and Central America, investigating attitudes toward end-of-life practices in health-care providers. Statistical analysis included descriptive statistics and χ2 test for the presence of associations (P < 0.05 being significant) and Cramer V for the strength of the association. The main outcome measured the correlation between the respondents’ present code status and their preference for cardiopulmonary resuscitation (CPR) in case of terminal illness.Results:A total of 852 surveys were completed. Among the respondents, 21% (n = 180) were physicians, 36.9% (n = 317) were nurses, 10.5% (n = 90) were medical students, and 265 participants were other staff members of the institutions. Most respondents (58.3%; n = 500) desired “definitely full code” (physicians 73.2%; n = 131), only 13.8% of the respondents (physicians 8.33%; n = 15) desired “definitely no code” or “partial support,” and 20.9% of the respondents (n = 179; among physicians 18.4%; n = 33) had never considered their code status. There was an association between current code status and resuscitation preference in case of terminal illness (P < .001), but this association was overall quite weak (Cramer V = 0.180). Subgroup analysis revealed no association between current code status and terminal illness code preference among physicians (P = .290) and nurses (P = .316), whereupon other hospital workers were more consistent (P < .01, Cramer V = .291).Conclusion:Doctors and nurses have different end-of-life preferences than other hospital workers. Their desire to undergo CPR may change when facing a terminal illness.

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