Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians

Abstract

Objective: To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians' perceptions of their patients' preferences and agreement between patients' and physicians' preferences, estimation of prognosis, and assessment of quality of life.

Design: Prospective cohort study.

Setting: Four academic hospitals.

Participants: Patients 80 years or older hospitalized between January 1993 and November 1994.

Measurements: Detailed clinical data were collected by chart review and interview. Patients and physicians were interviewed to determine their preferences for cardiopulmonary resuscitation (CPR). Agreement between patients and physicians was assessed using the kappa statistic, which measures agreement beyond chance.

Results: Of the 1266 patients studied, their median age was 85 years, and 61% were female. The majority (55%) of the 1010 patients with CPR preference information available desired CPR. Compared with patients, fewer physicians wanted CPR (36%) if they were in their patients' condition. Agreement between patients' preferences and physicians' perceptions of these preferences was low (absolute agreement 63%, kappa = 0.21). Agreement was better between physicians' perceptions of patients' preferences and physicians' desire for themselves if they were in their patients' condition (66%, kappa = 0.36). Agreement between patients' and physicians' estimates of survival was only slight (46%, kappa = 0.10). The majority of the disagreement occurred when the physician's prognostic estimate was worse than the patient's.

Conclusions: The majority of hospitalized patients 80 years older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians' estimates of patients' prognoses were less optimistic than patients' estimates, raising the possibility that physicians' knowledge of older patients' poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older.