Advance Directives, Cardiopulmonary Resuscitation, Communication, Decision Making
Conditions
Keywords
Older Adult, Allow a Natural Death, Do Not Resuscitate, Resuscitation Decisions
Brief summary
The purpose of the research is to determine how the language used when discussing preferences about cardiopulmonary resuscitation (CPR) affects decisions regarding this (code status)
Detailed description
Most Americans express a preference for dying at home naturally and surrounded by loved ones. However, many also believe that cardiopulmonary resuscitation (CPR) is more effective than it is, and want to have CPR even when the chances for a good outcome is poor. Among other reasons, the alternative term (Do Not Resuscitate, or DNR) has been shown in the literature to be associated by patients with passive, sub-optimal, and low quality care. This study will attempt to determine patient preference for the no CPR term on patients admitted to the hospital using alternate phrasing. During admission to the Medical Teaching Service, patients over the age of 65 who are able to consent and who are not critically ill/unstable will be approached. After checking brief background questions (such as if they ever had discussions like these before), they will be randomized into two groups and asked code status using one of the two phrases. This question will determine the patient's code status; asking for this is a routine part of hospitalized care that is required by law (the exact terminology is left to the care team). After determining the patient's code status, they will be asked how satisfied they were with the decision; the investigator will be asked if they agree with the decision separately. Demographic and clinical information will be collected. Six months later, the patient will be contacted again; at this time, they will be asked about recent life and health changes. Finally, they will be asked their code status one more time. This will conclude the participant's involvement in the study
Interventions
OTHERAlternative phrasing for no code
This intervention will use the alternative phrase noted in the literature when discussing code status. This will be the only intervention, and all other aspects of trial participation will be collection of data
OTHERStandard of care for no code
This intervention will use the standard of care phrase noted in the literature when discussing code status. This will be the only intervention, and all other aspects of trial participation will be collection of data
Sponsors
Rutgers, The State University of New Jersey
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* 65 or older * English-fluency in reading and speaking * Capacity to consent
Exclusion criteria
* Unstable psychiatric illness * Unstable/critically ill patients requiring ICU-level care * Active substance abuse
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Code Status Selection | Immediately collected after consent and randomization into a study arm | Selection of code versus no code decision depending on phrasing used, stratified by GO-FAR calculation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Participant Satisfaction with Decision | Immediately collected after consent and randomization into a study arm | Determine patient satisfaction of, and provider agreement with, code discussion. The former will be measured using a modified Satisfaction with Decision Scale, a six-item Likert scale indicating agreement or not with the statements provided. The latter will be determined by asking the physician if they agree (yes/no/unsure) |
| Length of Conversation | Immediately collected after consent and randomization into a study arm | Determine whether there is a difference of conversation length between phrasing groups (measured in minutes) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Durability of Code Status Decision In the Study Arms at 6 Months (Assessed by Asking Code Status Using the Intervention Phrase Again) | At approximately 6 months, patients will receive a follow-up phone call to determine this | Determine whether the decision made for code status is durable between the two groups. Patients will again be asked their code status as in outcome 1 during a follow-up phone call (after information about new medical experiences/diagnoses and other code status discussions in the last six months is collected) |
| Information That May Modify Outcomes 1-4 | Additional information collected initially will be at time of consent/randomization into the study arm; additional information collected at follow-up will be at approximately six months | To assess the possibility of other factors modifying the above outcomes, this study will collect additional information. Initially, we will ask about history of prior code status discussion; general demographic information (e.g., income, religion, etc); medical history (including diagnoses, medications, and substance use). At follow-up, we will ask about recent hospitalizations, new medical problems/medications, life stressors (using the Holmes-Rahe Index), and further discussions about code status |
Countries
United States
Contacts
Primary ContactKarthik Kota, MD MPH
Backup ContactMichael Steinberg, MD MPH
Outcome results
None listed