FACTORS INFLUENCING PHYSICIANS IN RECOMMENDING IN-HOSPITAL CARDIOPULMONARY-RESUSCITATION

Background: Cardiopulmonary resuscitation (CPR) is a dramatic, costly, and often futile intervention whose appropriate use is under scrutiny . Physicians often ask patients and families to make decisions about r esuscitation for themselves or loved ones. Clinical variables and pers onal beliefs may influence physician recommendations about CPR. Method s: Physicians (N=451) at a tertiary care hospital were surveyed to det ermine the following: (1) the factors they consider when recommending in-hospital CPR, (2) the conditions under which they discuss CPR with patients, (3) their recent participation in CPR attempts, (4) their pe rceptions of its effectiveness, (5) their personal wishes regarding th eir own resuscitation, and (6) their personal and professional charact eristics. Results: The patient's self-reported wishes about resuscitat ion and physician judgment of medical utility were the most important influences on physician recommendations. Most physicians believe that patients with metastatic cancer or late Alzheimer's disease should not be resuscitated. Age alone was not viewed as an important clinical co nsideration. Guidance from hospital policies and ethics committees had the least influence on physicians. Physicians overestimated the likel ihood of survival to hospital discharge after in-hospital CPR by as mu ch as 300% for some clinical situations and predicted an overall succe ss rate of 30%. Conclusion: These findings suggest that most physician s are thoughtful and discriminating in their recommendations to patien ts about CPR. Patient's wishes are of paramount importance, followed b y physician judgment of medical utility. However, physicians do overes timate the efficacy of CPR and may thus misrepresent the potential uti lity of this therapy to patients and their families.