Advanced Malignancy, Oxygen Dependent COPD
Conditions
Keywords
CPR, Palliative, Outcome
Brief summary
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.
Interventions
BEHAVIORALInformed Assent
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.
BEHAVIORALInformational Brochure
An informational brochure about CPR will be given without a discussion with a physician.
Sponsors
University of Vermont
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years or older * Oxygen dependent COPD or Advanced Malignancy * Life expectancy of less than two years
Exclusion criteria
* Subjects who have already firmly decided to undergo CPR * Subjects enrolled in a hospice program * Subjects unable to speak English * Subjects incapable of making their own decisions at the time of enrollment * Subjects cared for by the study investigator
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiopulmonary Resuscitation Preference | Within couple of hours before the intervention and immediately (up to 2 days) after the intervention | 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). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anxiety | Baseline (day of intervention) and two weeks after intervention | Patients and families will complete the GAD-7 questionnaire, a measure of generalized anxiety disorder. |
| Physician Order for Life Sustaining Treatment (POLST) | Baseline (day of intervention) and 2 weeks after intervention | 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. |
| DNR status preference | Two weeks after the intervention | The difference in DNR status preference between patients in the control and invervention group at two weeks after the intervention. |
| Depression | Baseline (day of intervention) and 2 weeks after intervention | Patients' and family members' symptomes of depression will be measured by the PHQ-8 questionnaire. |
| Assessment of DNR status change or intervention follow-up from primary physician | Three months after the intervention | 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. |
| Resource utilization | Up to 6 months after intervention or until death | Record resource utilization for participants that includes hospitalizations, ICU care, use of hospice etc by medical record review. |
| Report on acceptability of the informed assent approach | Within couple of hours (up to 2 weeks) after intervention | 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? |
Countries
United States
Outcome results
None listed