A prospective study of patient-physician communication about resuscitation

OBJECTIVE: To evaluate prospectively seriously ill patients' characteristic s, perceptions, and preferences associated with discussing resuscitation (C PR) with their physicians. DESIGN: Prospective cohort. SETTING: Five academic medical centers. PARTICIPANTS: Patients enrolled in the Study to Understand Prognoses and Pr eferences for Outcomes and Risks of Treatments who had not communicated wit h their physicians about CPR at admission to a hospital for life-threatenin g illness (n = 1288). MEASUREMENTS: Baseline surveys of patients' characteristics, health status, desires for participation in medical decision making, and cardiopulmonary resuscitation. Two month follow-up surveys of patients' communication of re suscitation preference. Chart reviews for clinical indicators. RESULTS: Thirty percent of patients communicated their resuscitation prefer ence to their physician during a 2 month-period following hospital admissio n. Patients whose preference was to forgo CPR (odds ratio (OR) 2.9;(95% CT, 1.94.2)) and whose preference had changed from desiring to forgoing CPR (O R 1.6; (95% CI, 1.1-2.4)) were more likely to communicate their preference than patients who continued to prefer to receive CPR. However, only 50 % of patients who maintained a preference to forgo CPR communicated this over a 2-month period. Having an advance directive and remaining in the hospital at 2-month follow-up were also independently associated with communication, whereas patients' preference for participation in decision-making, health status, and prognostic estimate were not. CONCLUSIONS: Communication about resuscitation preferences occurred infrequ ently after hospital admission for a serious illness, even among patients w ishing to forgo resuscitation. Factors such as declining quality of life, w hich were expected to be associated with communication, were not. An invita tion to communicate about CPR preference is important after hospital admiss ion for a serious illness. Novel approaches are needed to promote physician -patient discussions about resuscitation.