Outcomes after in-hospital cardiopulmonary resuscitation (CPR) are very poor, particularly in patients with oxygen dependent chronic obstructive pulmonary disease (COPD) or metastatic cancer. Recent work found that in-hospital CPR is being performed more often before death with unchanging survival and that fewer CPR survivors are being discharged home, thus suggesting that CPR is increasingly performed without benefit and that the burden of this ineffective treatment is increasing. Unlike other medical procedures, CPR has become the default provided to all patients even those with tremendously poor outcomes. It is time to change the paradigm of CPR. Through comparing an innovative "informed assent" approach toward in-hospital CPR (informing patients that their underlying chronic illness makes outcomes of CPR so poor that CPR is not performed while allowing them to disagree) versus usual care in a group of chronically ill patients with reduced life expectancy, the investigators aspire to demonstrate that CPR delivery can be reduced. And in addition that DNR status increases, while preserving patient quality of life and decreasing the burden of this ineffective treatment to both patients and families. If effective, this informed assent intervention has the potential to revolutionize how the investigators discuss CPR with the investigators chronically ill patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
29
Patients receive informed assent approach toward in-hospital CPR outcomes. Patients are informed that their underlying chronic illness makes outcomes after CPR so poor that CPR is not performed while allowing them to disagree.
An informational brochure about CPR will be given without a discussion with a physician.
Medical University of South Carolina
Charleston, South Carolina, United States
University of Vermont and Fletcher Allen Health Care
Burlington, Vermont, United States
University of Washington
Seattle, Washington, United States
Cardiopulmonary Resuscitation Preference
The primary outcome will be the difference in the proportion of patients in the informed assent intervention and informational brochure groups reporting preferences to be DNR (do not rescusitate).
Time frame: Within couple of hours before the intervention and immediately (up to 2 days) after the intervention
Depression
Patients' and family members' symptomes of depression will be measured by the PHQ-8 questionnaire.
Time frame: Baseline (day of intervention) and 2 weeks after intervention
Anxiety
Patients and families will complete the GAD-7 questionnaire, a measure of generalized anxiety disorder.
Time frame: Baseline (day of intervention) and two weeks after intervention
Physician Order for Life Sustaining Treatment (POLST)
Participants who expressed a preference to be DNR will be asked to complete a POLST form by their physician. It will also be explained that this can be changed any time the status changes.
Time frame: Baseline (day of intervention) and 2 weeks after intervention
DNR status preference
The difference in DNR status preference between patients in the control and invervention group at two weeks after the intervention.
Time frame: Two weeks after the intervention
Report on acceptability of the informed assent approach
The following questions will be asked: 1. How helpful was this approach to discussing CPR with respect to CPR decisions? 2. Would you recommend this approach to discussing CPR for other patients who have serious illnesses?
Time frame: Within couple of hours (up to 2 weeks) after intervention
Assessment of DNR status change or intervention follow-up from primary physician
Contact the physician for each patient at 3 months after the study visit to determine whether there are changes in the DNR status or if the physician has talked with the patients about the status since the study visit.
Time frame: Three months after the intervention
Resource utilization
Record resource utilization for participants that includes hospitalizations, ICU care, use of hospice etc by medical record review.
Time frame: Up to 6 months after intervention or until death
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