Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

“To Be or Not to Be”—Cardiopulmonary Resuscitation for Hospitalized People Who Have a Low Probability of Benefit: Qualitative Analysis of Semi-structured Interviews

“…Our team previously completed a randomized control trial of a decision support intervention that presented hospitalized patients who had already decided they wanted CPR but had low probability of success with probabilities of harm and benefit and a values clarification exercise. 8 We found no difference between groups in the proportion who chose CPR. The present study was motivated by a desire to understand our negative result and to understand more broadly why some people choose CPR despite a low probability of benefit.…”

“…To replicate what happened in the intervention arm of our RCT and to ensure that patients had engaged in a decision-making process and understood the choice options, they were shown a 7-min CPR video decision aid that included the harms, benefits, and probabilities of surviving CPR. 8 Participants interviewed in hospital viewed the video immediately prior to being interviewed. Those who were already discharged were sent a link to the video to view prior to the interview.…”

084 Supporting older patients in making healthcare decisions: the effectiveness of decision aids; a systematic review and meta-analysis

“…Six DAs aimed to support patients in making a treatment decision [38][39][40][41][42][43], two studies focused on decisions to participate in cancer screening programs [44,45], five on decisions concerning cardiopulmonary resuscitation (CPR) and intubation [46][47][48][49][50], one on prevention of falls [51], and one on both diagnosis and treatment of gastrointestinal cancer [52]. Eight studies compared the DA with usual care [38,39,42,43,[47][48][49], and eight compared the DA to an alternative intervention, such as educational pamphlets or verbal education [40,41,[44][45][46][50][51][52]. Most studies included participants from the age of 65 or older [40,41,46,[49][50][51], 70 or older [38,43,44], or 75 or older [45,47].…”

“…Most studies included participants from the age of 65 or older [40,41,46,[49][50][51], 70 or older [38,43,44], or 75 or older [45,47]. Three studies included participants with an age lower than 65 but reported a mean age of ≥ 70 years [39,42,48], and one study performed a subgroup analysis in older patients [52]. Four DAs were paper-based [38,44,45,51], and all others were digital or had a digital element integrated into the DA [39][40][41][42][43][46][47][48][49][50]52].…”

Fighting Fires and Battling the Clock: Advance Care Planning in Family Medicine Residency

“…Family doctors are ideally positioned to initiate advance care planning (ACP) to help patients with serious illness ensure that the medical care they receive is concordant with their values and wishes. 1 Patients with serious illness engaging in ACP with their doctors benefit from better knowledge of disease, 2 mood, 3,4 positive family outcomes, 4,5 documented goals, 4,5 and shared decision-making, 6 and may benefit from care that is more concordant with their goals 5,7 and location preferences 8 ; additionally, they experience less decisional conflict, 9 nonbeneficial medical care near death, and lower overall health care expenditure. [3][4][5]8,10,11 Unfortunately, while family physicians play the most central role in assessing and treating patients at the end of life, 12 fewer than one in 10 patients have conversations about their values and care preferences with their family physician, 13 despite an interest from patients in initiation of such conversations.…”