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Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients.

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Summary

The informed assent (IA) approach to discussing cardiopulmonary resuscitation (CPR) is acceptable and feasible for seriously ill patients. This method streamlines decision-making by informing patients that CPR will not be performed unless they disagree.

Keywords:
Code statuscardiopulmonary resuscitationcommunicationend-of-lifeseriously ill patients

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Area of Science:

  • Medical Ethics
  • Patient-Physician Communication
  • Cardiopulmonary Resuscitation

Background:

  • Outcomes following cardiopulmonary resuscitation (CPR) are frequently poor, necessitating improved communication strategies.
  • The "informed assent" (IA) approach has been developed over 10 years to facilitate discussions about CPR with chronically ill patients and their families.

Purpose of the Study:

  • To determine the acceptability and efficacy of IA discussions regarding CPR in older, chronically ill patients and their families.
  • To evaluate the IA approach as a framework for CPR decision-making.

Main Methods:

  • The research involved three stages: focus groups (Stage I), a pilot randomized controlled trial (RCT) (Stage II), and an ongoing phase 2 RCT (Stage III).
  • Participants included patients with advanced COPD or malignancy, family members, and physicians.
  • The ongoing RCT compares the IA approach to an attention control in hospitalized, seriously ill patients.

Main Results:

  • Qualitative findings indicated that the IA approach was acceptable to most patients, families, and physicians.
  • The pilot RCT demonstrated feasibility, with a notable increase in participants switching from "full code" to "do not resuscitate" status within two weeks.
  • Both Stages I and II suggested that IA is most suitable for inpatient settings.

Conclusions:

  • The informed assent (IA) approach is a feasible and reasonable method for discussing CPR.
  • IA is particularly effective in selected patient populations, especially inpatients.
  • This approach can simplify the decision-making process for CPR in complex medical situations.