John J You1, Dev Jayaraman2, Marilyn Swinton2, Xuran Jiang2, Daren K Heyland2. 1. Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont. John.You@thp.ca. 2. Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont.
Abstract
BACKGROUND: Inpatients are often prescribed cardiopulmonary resuscitation (CPR) without a shared decision-making process. Since implementation of decision aids into practice is highly sensitive to the clinical milieu, we performed a pilot study to refine our study procedures and to evaluate the acceptability and potential effectiveness of a shared decision-making intervention when implemented in a Canadian hospital setting. METHODS: In this before-after pilot study, we recruited patients and family members on the medical wards of 2 Canadian teaching hospitals between September 2015 and March 2017. The intervention consisted of viewing a CPR decision video and completing a values-clarification worksheet; follow-up discussion with the physician was encouraged. The primary feasibility outcome was acceptability of the video, and the primary effectiveness outcome was change in the Decisional Conflict Scale score (lower scores being more desirable) after the intervention. Participants rated the extent of shared decision-making using the CollaboRATE instrument. RESULTS: Of the 71 participants (43 patients with a mean age of 79.0 [standard deviation (SD) 11.4] yr and 28 family members with a mean age of 61.0 [SD 10.0] yr), 65 (92%) rated the CPR decision video as good to excellent. The intervention was associated with an improvement in knowledge about CPR (+2.7 points, 95% confidence interval [CI] 2.2 to 3.3, effect size 1.5) and a reduction in the Decisional Conflict Scale score (-18.1 points, 95% CI -21.8 to -14.3, effect size 1.4). The 36 participants who had a discussion with a physician about CPR after watching the video rated the extent of shared decision-making as 6.3 (SD 1.7) (possible maximum score 9). There was a nonsignificant decrease in the proportion of patients with a medical order for CPR after the intervention (71% before v. 63% after, p = 0.06). INTERPRETATION: The CPR decision video was acceptable to patients and family members. Our decision-support intervention may improve knowledge, reduce decisional conflict and reduce the prevalence of medical orders for CPR in the Canadian hospital setting. Copyright 2019, Joule Inc. or its licensors.
BACKGROUND: Inpatients are often prescribed cardiopulmonary resuscitation (CPR) without a shared decision-making process. Since implementation of decision aids into practice is highly sensitive to the clinical milieu, we performed a pilot study to refine our study procedures and to evaluate the acceptability and potential effectiveness of a shared decision-making intervention when implemented in a Canadian hospital setting. METHODS: In this before-after pilot study, we recruited patients and family members on the medical wards of 2 Canadian teaching hospitals between September 2015 and March 2017. The intervention consisted of viewing a CPR decision video and completing a values-clarification worksheet; follow-up discussion with the physician was encouraged. The primary feasibility outcome was acceptability of the video, and the primary effectiveness outcome was change in the Decisional Conflict Scale score (lower scores being more desirable) after the intervention. Participants rated the extent of shared decision-making using the CollaboRATE instrument. RESULTS: Of the 71 participants (43 patients with a mean age of 79.0 [standard deviation (SD) 11.4] yr and 28 family members with a mean age of 61.0 [SD 10.0] yr), 65 (92%) rated the CPR decision video as good to excellent. The intervention was associated with an improvement in knowledge about CPR (+2.7 points, 95% confidence interval [CI] 2.2 to 3.3, effect size 1.5) and a reduction in the Decisional Conflict Scale score (-18.1 points, 95% CI -21.8 to -14.3, effect size 1.4). The 36 participants who had a discussion with a physician about CPR after watching the video rated the extent of shared decision-making as 6.3 (SD 1.7) (possible maximum score 9). There was a nonsignificant decrease in the proportion of patients with a medical order for CPR after the intervention (71% before v. 63% after, p = 0.06). INTERPRETATION: The CPR decision video was acceptable to patients and family members. Our decision-support intervention may improve knowledge, reduce decisional conflict and reduce the prevalence of medical orders for CPR in the Canadian hospital setting. Copyright 2019, Joule Inc. or its licensors.
Authors: Vinay M Nadkarni; Gregory Luke Larkin; Mary Ann Peberdy; Scott M Carey; William Kaye; Mary E Mancini; Graham Nichol; Tanya Lane-Truitt; Jerry Potts; Joseph P Ornato; Robert A Berg Journal: JAMA Date: 2006-01-04 Impact factor: 56.272
Authors: Angelo E Volandes; Michael K Paasche-Orlow; Susan L Mitchell; Areej El-Jawahri; Aretha Delight Davis; Michael J Barry; Kevan L Hartshorn; Vicki Ann Jackson; Muriel R Gillick; Elizabeth S Walker-Corkery; Yuchiao Chang; Lenny López; Margaret Kemeny; Linda Bulone; Eileen Mann; Sumi Misra; Matt Peachey; Elmer D Abbo; April F Eichler; Andrew S Epstein; Ariela Noy; Tomer T Levin; Jennifer S Temel Journal: J Clin Oncol Date: 2012-12-10 Impact factor: 44.544
Authors: Daren K Heyland; Doris Barwich; Deb Pichora; Peter Dodek; Francois Lamontagne; John J You; Carolyn Tayler; Pat Porterfield; Tasnim Sinuff; Jessica Simon Journal: JAMA Intern Med Date: 2013-05-13 Impact factor: 21.873
Authors: Jianmin Tian; David A Kaufman; Stuart Zarich; Paul S Chan; Philip Ong; Yaw Amoateng-Adjepong; Constantine A Manthous Journal: Am J Respir Crit Care Med Date: 2010-04-22 Impact factor: 21.405
Authors: Paul James Barr; Rachel Thompson; Thom Walsh; Stuart W Grande; Elissa M Ozanne; Glyn Elwyn Journal: J Med Internet Res Date: 2014-01-03 Impact factor: 5.428
Authors: Daniel Kobewka; Daren K Heyland; Peter Dodek; Aman Nijjar; Nick Bansback; Michelle Howard; Peter Munene; Elizabeth Kunkel; Alan Forster; Jamie Brehaut; John J You Journal: J Gen Intern Med Date: 2021-02-02 Impact factor: 6.473
Authors: Spyros D Mentzelopoulos; Keith Couper; Patrick Van de Voorde; Patrick Druwé; Marieke Blom; Gavin D Perkins; Ileana Lulic; Jana Djakow; Violetta Raffay; Gisela Lilja; Leo Bossaert Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.826