Developing Guidelines On Code Status Conversations With Older Adults Upon Hospital Admission: Results From A Survey Of Experienced Healthcare Professionals

Abstract

Background: Shared decision-making is the cornerstone of patient-physician communication on life-sustaining therapies, such as cardio-pulmonary resuscitation (CPR). Nevertheless, the application of these standards to everyday medical practice in hospitals is limited. Our objective was to establish clear and comprehensive recommendations for junior physicians in our hospital regarding code status conversations. Methods: Provisional recommendations about CPR discussions between physicians and adult patients upon hospital admission were informed by a rapid review of the literature, and sent to 146 experienced healthcare professionals in French-speaking Switzerland, who were asked to evaluate each recommendation quantitatively and qualitatively, and to provide additional recommendations. Results: Based on a review of 53 articles, we formulated 11 provisional recommendations, which were evaluated by a panel of 39 experienced healthcare professionals. Overall agreement with all submitted recommendations was high (85%). Recommendations pertaining to physicians clarifying patients’ understanding of their medical state and prognosis at the start of the discussion, and approaching CPR in the context of goals of care, striving to clarify the patient’s values, purposes, preferences and expectations, had the greatest approval rate and were considered most important. Disagreement mostly concerned the need to discuss CPR with all patients. Conclusions: Our set of approved recommendations advocate a model of informed, shared decision making that reflect both the medical indication and patients’ life plans. These recommendations will serve as basis for devising a training for resident physicians, and will be adapted for other health professionals.