Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders

Becker, Christoph; Lecheler, Leopold; Hochstrasser, Seraina; Metzger, Kerstin; Widmer, Madlaina; Thommen, Emanuel; Nienhaus, Katharina; Ewald, Hannah; Meier, Christoph A.; Rueter, Florian; Schaefert, Rainer; Bassetti, Stefano; Hunziker, Sabina

doi:10.1001/jamanetworkopen.2019.5033

Cited by 46 publications

(39 citation statements)

References 61 publications

(168 reference statements)

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“…To achieve better patient counselling and to implement the right communication interventions, we must identify which patients need information, when they should receive it and how much is remembered. 19 The objective of this study was to provide an examination of patients' perceptions of CPR-directive counselling. The primary aim was to assess the prevalence of DNRorders.…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

Schluep

Hoeks

Endeman³

et al. 2020

Resuscitation

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Background:The decision to attempt or refrain from resuscitation is preferably based on prognostic factors for outcome and subsequently communicated with patients. Both patients and physicians consider good communication important, however little is known about patient involvement in and understanding of cardiopulmonary resuscitation (CPR) directives.Aim: To determine the prevalence of Do Not Resuscitate (DNR)-orders, to describe recollection of CPR-directive conversations and factors associated with patient recollection and understanding.Methods: This was a two-week nationwide multicentre cross-sectional observational study using a study-specific survey. The study population consisted of patients admitted to non-monitored wards in 13 hospitals. Data were collected from the electronic medical record (EMR) concerning CPRdirective, comorbidity and at-home medication. Patients reported their perception and expectations about CPR-counselling through a questionnaire.Results: A total of 1136 patients completed the questionnaire. Patients' CPR-directives were documented in the EMR as follows: 63.7% full code, 27.5% DNR and in 8.8% no directive was documented. DNR was most often documented for patients >80 years (66.4%) and in patients using >10 medications (45.3%). Overall, 55.8% of patients recalled having had a conversation about their CPR-directive and 48.1% patients reported the same CPR-directive as the EMR. Most patients had a good experience with the CPR-directive conversation in general (66.1%), as well as its timing (84%) and location (94%) specifically. Conclusions:The average DNR-prevalence is 27.5%. Correct understanding of their CPR-directive is lowest in patients aged !80 years and multimorbid patients. CPR-directive counselling should focus more on patient involvement and their correct understanding.

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Section: Introductionmentioning

confidence: 99%

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

Schluep

Hoeks

Endeman³

et al. 2020

Resuscitation

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“…60 , 61 Prior research in other populations suggests that patients are less likely to want to be resuscitated when they are informed about the expected outcome. 32 , 62 , 63 , 64 …”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis

et al. 2020

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“…This is in accordance with previous findings that a communication intervention decreases patients’ preferences for CPR and suggests that enquiring about CS in the ED identified some patients with DNR preferences who were not being identified in the inpatient setting. 18 Future study is perhaps warranted to identify patient factors related to this.…”

Section: Discussionmentioning

confidence: 99%

Is the Emergency Department an Inappropriate Venue for Code Status Discussions?

Miller

Vakkalanka

Nugent

et al. 2020

Am J Hosp Palliat Care

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Background: Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution’s aforementioned CSO mandate. Methods: We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy. Results: Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p <0.001), and DNR orders placed during inpatient admission was unchanged (RR=0.97 (95% CI = 0.88-1.07)). Discussion: Our results suggest that the ED can be an appropriate venue for CSDs.

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Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders

Cited by 46 publications

References 61 publications

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

A cross-sectional investigation of communication in Do-Not-Resuscitate orders in Dutch hospitals

Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis

Is the Emergency Department an Inappropriate Venue for Code Status Discussions?

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