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Code status discussions and goals of care among hospitalised adults
  1. L C Kaldjian1,2,3,
  2. Z D Erekson4,
  3. T H Haberle4,
  4. A E Curtis1,2,3,
  5. L A Shinkunas3,
  6. K T Cannon1,2,3,
  7. V L Forman-Hoffman1,3
  1. 1
    Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  2. 2
    Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
  3. 3
    Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USA
  4. 4
    University of Iowa, Carver College of Medicine, Iowa City, Iowa, USA
  1. Dr L C Kaldjian, Department of Internal Medicine, 1-106 MEB, University of Iowa Carver College of Medicine, 500 Newton Road, Iowa City, Iowa 52242, USA; lauris-kaldjian{at}uiowa.edu

Abstract

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care.

Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information and code status documentation.

Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%).

Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences.

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Footnotes

  • Partial data from this study were presented at the Society of General Internal Medicine’s 31st Annual Meeting in Pittsburgh, Pennsylvania, USA, and have been published as abstracts (J Gen Intern Med 2008;23(Suppl 2):267,308).

  • Funding: This study was funded in part by grant support from the University of Iowa Carver College of Medicine to ZDE and THH and by funding from the Veterans Administration National Quality Scholars Program to AEC and KTC.

  • Competing interests: None.

  • Ethics approval: The University of Iowa institutional review board approved the study.

  • LCK and VLF-H are investigators in the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the VA Iowa City VA Health Care System, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service.

  • Provenance and Peer review: Not commissioned; externally peer reviewed.

  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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