Daniel Kobewka1,2,3, Daren K Heyland4, Peter Dodek5, Aman Nijjar6, Nick Bansback5,7, Michelle Howard8,9, Peter Munene10, Elizabeth Kunkel11,10,12,13, Alan Forster11,10,12, Jamie Brehaut11,12, John J You14. 1. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. dkobewka@toh.ca. 2. Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. dkobewka@toh.ca. 3. School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada. dkobewka@toh.ca. 4. Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. 5. Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada. 6. General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 7. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. 8. Department of Family Medicine, McMaster University, Hamilton, ON, Canada. 9. David Braley Health Sciences Centre, Hamilton, ON, Canada. 10. Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. 11. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 12. School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada. 13. Department of National Defence, Ottawa, ON, Canada. 14. Division of General Internal and Hospitalist Medicine, Department of Medicine, Credit Valley Hospital, Trillium Health Partners, Mississauga, Ontario, Canada.
Abstract
BACKGROUND: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. OBJECTIVE: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. DESIGN: Open-label randomized controlled trial. PATIENTS: Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. INTERVENTION: Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. MAIN MEASURE: The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment. KEY RESULTS: We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict). CONCLUSIONS: Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. PRIMARY FUNDING SOURCE: Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.
BACKGROUND: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. OBJECTIVE: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. DESIGN: Open-label randomized controlled trial. PATIENTS: Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. INTERVENTION: Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. MAIN MEASURE: The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment. KEY RESULTS: We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict). CONCLUSIONS: Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. PRIMARY FUNDING SOURCE: Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.
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: J Randall Curtis; Lois Downey; Anthony L Back; Elizabeth L Nielsen; Sudiptho Paul; Alexandria Z Lahdya; Patsy D Treece; Priscilla Armstrong; Ronald Peck; Ruth A Engelberg Journal: JAMA Intern Med Date: 2018-07-01 Impact factor: 21.873
Authors: Glyn Elwyn; Annette O'Connor; Dawn Stacey; Robert Volk; Adrian Edwards; Angela Coulter; Richard Thomson; Alexandra Barratt; Michael Barry; Steven Bernstein; Phyllis Butow; Aileen Clarke; Vikki Entwistle; Deb Feldman-Stewart; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Nora Moumjid; Al Mulley; Cornelia Ruland; Karen Sepucha; Alan Sykes; Tim Whelan Journal: BMJ Date: 2006-08-14