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Understanding Cardiopulmonary Resuscitation Decision Making^*

Perspectives of Seriously Ill Hospitalized Patients and Family Members

^* From the Department of Medicine (Drs. Heyland, Frank, and Groll, and Ms. Pichora), Kingston General Hospital, Kingston, ON, Canada; the Program in Critical Care Medicine (Dr. Dodek), St. Paul’s Hospital, Vancouver, BC, Canada; the Department of Medicine (Dr. Rocker), Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada; and the Center for Health Economics and Policy Analysis (Dr. Gafni), McMaster University, Hamilton, ON, Canada.

Correspondence to: Daren K. Heyland, MD, MSc, Angada 4, Kingston General Hospital, Kingston, ON, Canada K7L 2V7; e-mail: dkh2{at}post.queensu.ca

Abstract

Background: To improve communication and decision making related to cardiopulmonary resuscitation (CPR), a greater understanding of the perspectives of hospitalized patients with advanced diseases and their family members are needed.

Methods: In five Canadian hospitals, we administered a face-to-face questionnaire to older inpatients with end-stage cancer and advanced medical diseases and, where possible, to one of their family members, regarding information needs, the deliberation process, and their preferred decisional role.

Findings: A total of 440 of 569 patients (78%) and 160 of 176 available caregivers (91%) agreed to participate. Most patients (61%) had thought about what treatment they wanted if their heart stopped, few patients (11.3%) could describe more than two components of CPR, and only 2.7% of patients thought that the success rate of CPR was < 10%. A minority of patients (34%) had discussed CPR with their physician; 37% did not want to discuss their preferences with their doctor. Patients who felt that end-of-life issues were relevant to them were 5.5 times more likely to want a discussion with the physician regarding resuscitation (odds ratio, 5.5; 95% confidence interval, 2.5 to 12.0). The preferred role in decision making was variable, but most patients (59.7%) and family members (81.6%) preferred some degree of shared decision making that included the family member. There were no significant differences between cancer and medical patients in their preferred decisional role.

Interpretation: Seriously ill hospitalized patients have poor knowledge about CPR, and variable preferences for deliberation and their role in the decision-making process regarding their treatment. Strategies that improve understanding of CPR and foster discussions that involve patients, family members, and physicians in the decision-making process may improve the quantity and quality of communication and decision making about CPR.

Key Words: cardiopulmonary resuscitation • clinical decision making • end-of-life care