Characterizing Physician Recommendations within Code Status Documentation: A Multicentre Cohort Study and Qualitative...

Area of Science:

• Medical Ethics
• Geriatric Medicine
• Health Communication

Background:

• Discussions about patient treatment preferences for cardiopulmonary resuscitation (CPR) are standard for hospitalized adults.
• These code status discussions aim to align patient care with their values and priorities.
• The extent of physician recommendations during these crucial conversations remains unclear.

Purpose of the Study:

• To characterize the nature and extent of physician treatment recommendations during code status discussions.
• Focus on older hospitalized medical patients (75 years and older).

Main Methods:

• Retrospective cohort study of 200 patients aged 75+ admitted to a general medical service in Toronto, Canada.
• Qualitative discourse analysis of medical records documenting code status discussions.
• Focused on physician treatment recommendations and their documented rationale.

Main Results:

• Most physician recommendations favored de-escalation or avoidance of invasive treatments.
• Physician roles ranged from providing advice to actively withholding interventions.
• Rationales often cited poor prognosis or interpreted patient goals, but documentation of how goals were determined was scarce.
• The term "quality of life" was sometimes used to suggest treatments were not beneficial.

Conclusions:

• Physician practices in making recommendations during code status discussions varied significantly.
• A common deficiency was the lack of documented patient goals and priorities underpinning treatment recommendations.
• There is a clear opportunity to enhance how physicians formulate, communicate, and document recommendations in code status discussions.