Uninformed consent: Do medicine residents lack the proper framework for code status discussions?

Abstract

Background: Conversations eliciting patient preferences about cardiopulmonary resuscitation (CPR) are among the most common examples of informed consent. However, this is rarely recognized and therefore may not include all key elements of informed consent, namely, details and benefits of the procedure, significant risks involved, likelihood of the outcome, and alternative therapeutic options.

Objective: Assess the content of code status discussions as reported by residents to examine whether residents meet requirements of informed consent.

Design: Prospective, observational, single-center survey study.

Setting: Internal medicine residents at an academic medical center.

Intervention: Medicine residents were surveyed and data were anonymously collected.

Measurements: Content of code status discussions and knowledge of CPR outcomes.

Results: Among 100 respondents, 66% have code status discussions with most patients upon hospital admission. Two main barriers to discussing code status were lack of time (49%) and lack of rapport (29%). Only 8% reported discussing all 5 elements of informed consent. Less than 10% of the residents correctly answered questions testing knowledge regarding outcomes after cardiac arrest. In logistical regression analyses, residents who included all key elements of informed consent reported more confidence that they provided the information needed for patients to make an informed decision (odds ratio 1.7 [95% confidence interval: 1.2-2.3]).

Conclusions: Resident conversations regarding CPR are insufficient in the 5 key elements of informed consent. Framing code status discussions as examples of informed consent may be an effective strategy for educating residents or may improve the quality of these discussions, potentially leading to better patient decisions.