Factors Influencing Physicians' Code Status Decision-Making: An Experimental Vignette-Based Survey.

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Healthcare Policy

Background:

• Hospitals worldwide increasingly require documented code status for all inpatients.
• Establishing code status should be a shared decision between patient and physician.
• Current consensus on how to establish code status and influencing factors is lacking.

Purpose of the Study:

• To identify physician and patient characteristics that influence physicians' code status decision-making.
• To explore factors contributing to variability in resuscitation recommendations.

Main Methods:

• A vignette-based survey was conducted with physicians in a tertiary university hospital.
• Physicians were randomly assigned to groups and responded to clinical vignettes requiring a code status decision.
• The study utilized self-report online questionnaires with demographic and clinical scenario questions.

Main Results:

• Physicians from surgery were more likely to recommend resuscitation than those from medicine.
• Physicians with intensive care unit (ICU) experience were less likely to recommend resuscitation in certain scenarios.
• Patient factors like being a physician themselves or being younger significantly influenced resuscitation decisions, irrespective of terminal illness.

Conclusions:

• Physician-specific characteristics contribute to heterogeneity in code status decision-making.
• Patient factors unrelated to resuscitation outcomes significantly impact physician decisions.
• Enhanced training is needed for physicians on code status conversations, resuscitation outcomes, and decision-making reflexivity.