Unpacking resident-led code status discussions: results from a mixed methods study.

Area of Science:

• Medical Education
• Clinical Communication
• End-of-Life Care

Background:

• Code status discussions (CSDs) often lack patient-centeredness, failing to address goals of care and resuscitation outcomes.
• Prior research showed communication skills training improved CSD checklist scores in internal medicine residents.
• The specific impact of such training on the content of CSDs was previously unexamined.

Purpose of the Study:

• To compare the content of simulated code status discussions (CSDs) between internal medicine residents who received communication skills training and those who did not.
• To identify specific CSD themes influenced by communication skills intervention.

Main Methods:

• Qualitative analysis of 51 simulated CSD transcripts from 56 internal medicine residents (25 intervention, 31 control).
• Themes identified included: patient values/goals, patient-driven decisions, resuscitation outcomes, quality of life, and recommendations.
• Chi-square tests were used to compare theme presence between intervention and control groups.

Main Results:

• Intervention residents were significantly more likely to explore patient values/goals (p=0.002) and make a recommendation (p<0.001).
• Intervention residents were less likely to frame code status as solely a patient decision (p=0.01).
• Fewer than one-third of all residents discussed resuscitation outcomes or quality of life.

Conclusions:

• Communication skills training positively impacts key aspects of CSD content, specifically patient values and resident recommendations.
• The training helped residents avoid framing code status as exclusively a patient's decision.
• Despite training, discussing resuscitation outcomes and quality of life remains a challenge in CSDs.