Physician understanding of patient resuscitation preferences: Insights andclinical implications

OBJECTIVE: To describe physician understanding of patient preferences conce rning cardiopulmonary resuscitation (CPR) and to assess the relationship of physician understanding of patient preferences with do not resuscitate (DN R) orders and in-hospital CPR. DESIGN: We evaluated physician understanding of patient CPR preference and the association of patient characteristics and physician-patient communicat ion with physician understanding of patient CPR preferences. Among patients preferring to forgo CPR, we compared attempted resuscitations and time to receive a DNR order between patients whose preference was understood or mis understood by their physician. PATIENTS/SETTING: Seriously ill hospitalized adult patients were enrolled i n the Study to Understand Prognoses and Preferences for the Outcomes of Tre atments. GENERAL RESULTS: Physicians understood 86% of patient preferences for CPR, but only 46% of patient preferences to forgo CPR. Younger patient age, high er physician-estimated quality of life, and higher physician prediction of 6-month survival were independently associated with both physician understa nding when a patient preferred to receive CPR and physician misunderstandin g when a patient preferred to forgo CPR. Physicians who spoke with patients about resuscitation and had longer physician-patient relationships underst ood patients' preferences to forgo CPR more often. Patients whose physician s understood their preference to forgo CPR more often received DNR orders, received them earlier, and were significantly less likely to undergo resusc itation. CONCLUSIONS: Physicians often misunderstand seriously ill, hospitalized pat ients' resuscitation preferences, especially preferences to forgo CPR. Fact ors associated with misunderstanding suggest that physicians infer patients ' preferences without asking the patient. Patients who prefer to forgo CPR but whose wishes are not understood by their physician may receive unwanted treatment.