Scientific Publications Database

Article Title: Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death
Authors: Kobewka, Daniel; Heyland, Daren K.; Dodek, Peter; Nijjar, Aman; Bansback, Nick; Howard, Michelle; Munene, Peter; Kunkel, Elizabeth; Forster, Alan; Brehaut, Jamie; You, John J.
Journal: JOURNAL OF GENERAL INTERNAL MEDICINE Volume 36 Issue 9
Date of Publication:2021
Abstract:
BACKGROUND: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.OBJECTIVE: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care.DESIGN: Open-label randomized controlled trial.PATIENTS: Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed.INTERVENTION: Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid.MAIN MEASURE: The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment.KEY RESULTS: We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict).CONCLUSIONS: Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care.