Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered Frameworks.

Abstract

Background: Helping patients make decisions about their preferences for cardiopulmonary resuscitation (i.e., code status) is an important way to respect patient autonomy in the hospital. There is a gap in understanding which framework of discussion patients prefer for this decision-making.

Objective: To determine which of two frameworks to code status discussions-information-centered or patient values-centered-make patients feel more heard and understood about their preferences regarding cardiopulmonary resuscitation (CPR).

Design: Prospective, randomized study comparing two different frameworks to CPR discussion.

Participants: We enrolled adult patients with one or more serious illnesses who were recently discharged from an urban, tertiary care, academic medical center in Boston, MA.

Interventions: Subjects were randomized to receive either the information-centered framework, in which their likelihood of recovery following CPR was shared, or the patient values-centered framework, in which their personal values were elicited and used to make a recommendation.

Main measures: Subject-reported heard and understood rating with regard to their preferences for CPR.

Key results: Of the 46 subjects enrolled, 25 (54.3%) were male, 42 (91.3%) were White, and 3 (6.5%) were Black. Mean age was 66.4 ± 11.8 years. Subjects reported feeling more "heard and understood" about their preferences for CPR with the patient values-centered framework compared with after the information-centered framework (p = 0.033). When asked, 89% of subjects "definitely" or "probably" wanted to hear their doctor's personalized recommendation about CPR (p < 0.001).

Conclusion: Patients, in line with palliative care experts, largely support a patient values-centered framework to CPR, including a recommendation made by the clinician based on the patient's expressed values.