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. 2014 Apr 14;4(2).
doi: 10.3402/jchimp.v4.23745. eCollection 2014.

Use of a standardized code status explanation by residents among hospitalized patients

Kriti Mittal  1 , Kapil Sharma  2 , Neha Dangayach  3 , Dhaval Raval  4 , Katherine Leung  5 , Susan George  6 , George Abraham  6
Affiliations

Use of a standardized code status explanation by residents among hospitalized patients

Kriti Mittal et al. J Community Hosp Intern Med Perspect. .

Abstract

Objectives: There is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.

Methods: This was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.

Results: The composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.

Conclusion: The scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.

Practice implications: Standardized discussion of code status and training in communication of end-of-life care merit further research.

Keywords: Code status; cardiopulmonary resuscitation; end-of-life discussion; physician–patient communication.

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Figures

Fig. 1
Fig. 1
CONSORT flow diagram depicting flow of patients.
See this image and copyright information in PMC

References

    1. White ML, Fletcher JC. The patient self-determination act on balance, more help than hindrance. J Am Med Assoc. 1991;266(3):410–12. - PubMed
    1. Gillick MR. Advance care planning. N Engl J Med. 2004;350(1):7–8. - PubMed
    1. Phillips RS, Wenger NS, Teno J, Oye RK, Youngner S, Califf R, et al. Choices of seriously ill patients about cardiopulmonary resuscitation: Correlates and outcomes. Am J Med. 1996;100:128–37. - PubMed
    1. Knauft E, Nielson EL, Engelberg RA, Patrick DL, Curtis JR. Barriers and facilitators to end-of-life-care communication for patients with COPD. Chest. 2005;127:2188–96. - PubMed
    1. Momen NC, Barclay SIG. Addressing ‘the elephant on the table’: Barriers to end of life care conversations in heart failure – A literature review and narrative synthesis. Curr Opin Supp Palliat Care. 2011;5:312–16. - PubMed

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