DECIDING ABOUT CARDIOPULMONARY-RESUSCITATION - THE CONTRIBUTIONS OF DECISION-ANALYSIS

Background: Patients have the right to decide whether to authorize car diopulmonary resuscitation (CPR). Physicians should provide adequate i nformation and help clarify preferences. Methods: The usefulness of de cision analysis was investigated in two convenience samples: 20 health y outpatient volunteers and 35 audience members at medical ethics gran d rounds. Subjects quantified their relative preferences (utilities) f or the outcomes of cardiac arrest. First, they rated them on a linear scale. Second, they participated in hypothetical gambles in which they indicated how much they would risk to avoid each outcome. The investi gator then calculated the overall expected utilities of the CPR and no -CPR strategies. Results: Subjects were able to complete both the gamb les ods differed greatly. Subjects had strong aversions to an outcome of severe long-term brain damage and widely varying ratings of an outc ome of a short period of intensive care followed by death (intensive c are unit death). Because intensive care unit death is far more likely than long-term brain damage, its utility was the prime determinant of whether CPR or no-CPR had the higher calculated expected utility.Concl usions: The methods of decision analysis showed promise as a means not only of informing patients about CPR but of helping them make rationa l choices. They also revealed the inadequacy of current data on the ke y outcome of intensive care unit death.