Randomized Controlled Trial

. 2021 Sep;36(9):2593-2600.

doi: 10.1007/s11606-021-06605-y. Epub 2021 Feb 2.

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

Daniel Kobewka^{1

2

3}, Daren K Heyland⁴, Peter Dodek⁵, Aman Nijjar⁶, Nick Bansback^{5

7}, Michelle Howard^{8

9}, Peter Munene¹⁰, Elizabeth Kunkel^{11

10

12

13}, Alan Forster^{11

10

12}, Jamie Brehaut^{11

12}, John J You¹⁴

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dkobewka@toh.ca.
² Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. dkobewka@toh.ca.
³ School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada. dkobewka@toh.ca.
⁴ Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
⁵ Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
⁶ General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁷ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
⁸ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁹ David Braley Health Sciences Centre, Hamilton, ON, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹² School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of National Defence, Ottawa, ON, Canada.
¹⁴ Division of General Internal and Hospitalist Medicine, Department of Medicine, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada.

PMID: 33528779
PMCID: PMC8390722
DOI: 10.1007/s11606-021-06605-y

Randomized Controlled Trial

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

Daniel Kobewka et al. J Gen Intern Med. 2021 Sep.

. 2021 Sep;36(9):2593-2600.

doi: 10.1007/s11606-021-06605-y. Epub 2021 Feb 2.

Authors

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dkobewka@toh.ca.
² Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. dkobewka@toh.ca.
³ School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada. dkobewka@toh.ca.
⁴ Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
⁵ Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
⁶ General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁷ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
⁸ Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
⁹ David Braley Health Sciences Centre, Hamilton, ON, Canada.
¹⁰ Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
¹¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹² School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada.
¹³ Department of National Defence, Ottawa, ON, Canada.
¹⁴ Division of General Internal and Hospitalist Medicine, Department of Medicine, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada.

PMID: 33528779
PMCID: PMC8390722
DOI: 10.1007/s11606-021-06605-y

Abstract

Background: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.

Objective: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care.

Design: Open-label randomized controlled trial.

Patients: Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed.

Intervention: Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid.

Main measure: The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment.

Key results: We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict).

Conclusions: Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care.

Primary funding source: Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

**Figure 1**
**Consort flow diagram. CPR, cardiopulmonary resuscitation; SDM, substitute decision maker.**

See this image and copyright information in PMC

References

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1. Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, et al. Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Intern Med. 2013;173(9):778–87. doi: 10.1001/jamainternmed.2013.180. - DOI - PubMed

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Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

Affiliations

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

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LinkOut - more resources

Full Text Sources

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Medical