If Asked, Hospitalized Patients Will Choose Whether to Receive Life-Sustaining Therapies

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Abstract

BACKGROUND

No national policy requires health care providers to discuss with hospitalized patients whether the latter would want cardiopulmonary resuscitation (CPR) or mechanical ventilation (MV) in the event of cardiopulmonary failure.

OBJECTIVE

To determine whether hospitalized patients are willing to discuss end-of-life issues and choose whether to receive CPR and MV.

DESIGN

Prospective randomized trial.

PARTICIPANTS

297 patients admitted to the medicine service of a 350-bed community teaching hospital.

INTERVENTION

Patients were randomized to receive routine care or a scripted intervention, delivered by research physicians, that included detailed information about CPR, MV, and advance directives.

MEASUREMENTS

Number of patients who welcomed the scripted intervention, number who chose to receive or reject CPR/MV, and number of advance directives created during hospitalization.

RESULTS

Of the 297 patients studied, 136 were in the intervention group and 161 were in the control group. Baseline characteristics and severity of illness were similar in the 2 groups. Of the 136 patients in the intervention group, 133 (98%) willingly discussed CPR and mechanical ventilation, and 112 (82%) found the information useful. One hundred and twenty-five (92%) clarified their preferences regarding CPR and MV after receiving the intervention; of the 48 patients who were initially documented as wanting CPR/MV, 3 requested no CPR/MV after the intervention. Of the 87 patients in the intervention group who had no documentation of code status on admission, 5 asked for no CPR/MV. Of the 161 patients in the control group, 55 had documentation of their code status on admission. Of the 106 patients without documentation, 6 were later documented to receive no CPR/MV. Thirteen of the 102 patients who had no advance directive on admission created one after the intervention, whereas only 1 of the 128 patients in the control group did so (P < .001).

CONCLUSIONS

Patients are willing to discuss and give informed consent for CPR and mechanical ventilation early in hospitalization. Only a minority drafted advance directives during hospitalization. Larger studies that include patients at other centers are required to determine whether these findings are reproducible and whether this approach is clinically feasible.

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