Understanding cardiopulmonary resuscitation decision making: perspectives of seriously ill hospitalized patients and family members.

Abstract

BACKGROUND:

To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed.

METHODS:

In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role.

FINDINGS:

A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%) had discussed CPR with their physician; 37% did not want to discuss their preferences with their doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation (odds ratio, 5.5; 95% confidence interval, 2.5 to 12.0). The preferred role in decision making was variable, but most patients (59.7%) and family members (81.6%) preferred some degree of shared decision making that included the family member. There were no significant differences between cancer and medical patients in their preferred decisional role.

INTERPRETATION:

Seriously ill hospitalized patients have poor knowledge about CPR, and variable preferences for deliberation and their role in the decision-making process regarding their treatment. Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR.

• Authors: Daren K Heyland, Chris Frank, Dianne Groll, Deb Pichora, Peter Dodek, Graeme Rocker, Amiram Gafni
• Journal: Chest (Chest) Vol. 130 Issue 2 Pg. 419-28 (Aug 2006) ISSN: 0012-3692 [Print] United States
• PMID: 16899840 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Topics

• Aged
• Canada
• Cardiopulmonary Resuscitation (psychology)
• Critical Illness (psychology, therapy)
• Decision Making
• Female
• Follow-Up Studies
• Humans
• Inpatients
• Male
• Middle Aged
• Patient Education as Topic
• Patient Participation
• Physician-Patient Relations
• Resuscitation Orders
• Surveys and Questionnaires
• Terminal Care (methods)