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

Full 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.

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Author information

Author/s: Heyland, Daren K (DK); Frank, Chris (C); Groll, Dianne (D); Pichora, Deb (D); Dodek, Peter (P); Rocker, Graeme (G); Gafni, Amiram (A);

Affiliation: Department of Medicine, Kingston General Hospital, ON, Canada.

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study

Journal: Chest (Chest), published in United States. (Language: eng)

Reference: 2006-Aug; vol 130 (issue 2) : pp 419-28

Dates: Created 2006/08/10; Completed 2006/09/12; Revised 2007/11/15;

PMID: 16899840, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Canada
Cardiopulmonary Resuscitation - psychology
Critical Illness - psychology; therapy
Decision Making
Female
Follow-Up Studies
Humans
Inpatients

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