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Uninformed consent: Do medicine residents lack the proper framework for code status discussions?
Adam F Binder1, Grace C Huang2, Mary K Buss3
1Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Journal of Hospital Medicine
|October 17, 2015
Summary
Resident discussions about cardiopulmonary resuscitation (CPR) often lack key informed consent elements. Improving these conversations may enhance patient decision-making and understanding of CPR outcomes.
Area of Science:
- Medical Ethics
- Patient Communication
- Informed Consent
Background:
- Cardiopulmonary resuscitation (CPR) discussions are common informed consent examples.
- These conversations frequently omit crucial elements like risks, benefits, and alternatives.
Purpose of the Study:
- To evaluate the content of code status discussions by residents.
- To determine if residents meet informed consent requirements during these discussions.
Main Methods:
- Prospective, observational, single-center survey study.
- Internal medicine residents at an academic medical center were surveyed anonymously.
- Survey assessed content of code status discussions and knowledge of CPR outcomes.
Main Results:
- Only 8% of residents discussed all five elements of informed consent.
- Lack of time (49%) and rapport (29%) were primary barriers.
- Residents discussing all elements reported higher confidence in patient understanding.
Conclusions:
- Resident code status discussions are often incomplete regarding informed consent.
- Framing these discussions as informed consent examples could improve quality and patient decisions.
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