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.

journal_name

Chest

journal_title

Chest

authors

Heyland DK,Frank C,Groll D,Pichora D,Dodek P,Rocker G,Gafni A

doi

10.1378/chest.130.2.419

subject

Has Abstract

pub_date

2006-08-01 00:00:00

pages

419-28

issue

2

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)51856-4

journal_volume

130

pub_type

杂志文章,多中心研究

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