A Randomized Controlled Trial of a CPR Decision Support Video for Patients Admitted to the General Medicine Service

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Abstract

BACKGROUND:

Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process.

OBJECTIVES:

We examined the effect of an informational video about CPR on hospitalized patients' code status choices.

DESIGN:

This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota.

PARTICIPANTS:

We enrolled 119 patients, hospitalized on the general medicine service, and at least 65 years old. The majority were men (97%) with a mean age of 75.

INTERVENTION:

A video described code status choices: full code (CPR and intubation if required), do not resuscitate (DNR), and do not resuscitate/do not intubate (DNR/DNI). Participants were randomized to watch the video (n = 59) or usual care (n = 60).

MEASUREMENTS:

The primary outcome was participants' code status preferences. Secondary outcomes included a questionnaire designed to evaluate participants' trust in their healthcare team and knowledge and perceptions about CPR.

RESULTS:

Participants who viewed the video were less likely to choose full code (37%) compared to participants in the usual care group (71%) and more likely to choose DNR/DNI (56% in the video group vs. 17% in the control group) (P < 0.00001). We did not see a difference in trust in their healthcare team or knowledge and perceptions about CPR as assessed by our questionnaire.

CONCLUSIONS:

Hospitalized patients who watched a video about CPR and code status choices were less likely to choose full code and more likely to choose DNR/DNI.

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