Journal article
Code status discussions and goals of care among hospitalised adults
Journal of medical ethics, Vol.35(6), pp.338-342
06/2009
DOI: 10.1136/jme.2008.027854
PMID: 19482974
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.
Details
- Title: Subtitle
- Code status discussions and goals of care among hospitalised adults
- Creators
- L C Kaldjian - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USAZ D Erekson - University of Iowa, Carver College of Medicine, Iowa City, Iowa, USAL A Shinkunas - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USAV L Forman-Hoffman - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USAT H Haberle - University of Iowa, Carver College of Medicine, Iowa City, Iowa, USAA E Curtis - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USAK T Cannon - Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Journal of medical ethics, Vol.35(6), pp.338-342
- DOI
- 10.1136/jme.2008.027854
- PMID
- 19482974
- ISSN
- 0306-6800
- eISSN
- 1473-4257
- Language
- English
- Date published
- 06/2009
- Academic Unit
- Medical Ethics; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094396502771
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