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Patient Preferences for Code Status Discussions: A Randomized Trial of Information- vs. Patient Values-Centered
Christopher Joshi1, Sehrish Malik2, Wei Wang3,4
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA. cjoshi@bidmc.harvard.edu.
Journal of General Internal Medicine
|December 11, 2024
Summary
Patients prefer a values-centered approach for cardiopulmonary resuscitation (CPR) discussions, feeling more heard and understood. Most patients want clinician recommendations based on their personal values.
Area of Science:
- Medical Ethics
- Patient Autonomy
- Clinical Communication
Background:
- Respecting patient autonomy in hospitals involves code status discussions.
- A gap exists in understanding patient preferences for these decision-making frameworks.
Purpose of the Study:
- To compare patient feelings of being heard and understood between information-centered and patient values-centered frameworks for cardiopulmonary resuscitation (CPR) discussions.
- To determine patient preference for CPR discussion frameworks.
Main Methods:
- A prospective, randomized study compared two CPR discussion frameworks.
- Adult patients with serious illnesses were randomized to either an information-centered or a patient values-centered framework.
- Patient-reported "heard and understood" ratings were the primary outcome measure.
Main Results:
- Patients felt significantly more "heard and understood" with the patient values-centered framework compared to the information-centered framework (p=0.033).
- 89% of subjects desired a personalized clinician recommendation regarding CPR (p<0.001).
Conclusions:
- Patients largely favor a patient values-centered framework for CPR discussions.
- Clinician recommendations based on patient values are supported, aligning with palliative care expert consensus.
Keywords:
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