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Use of a standardized code status explanation by residents among hospitalized patients.

Mittal K, Sharma K, Dangayach N, Raval D, Leung K, George S, Abraham G - J Community Hosp Intern Med Perspect (2014)

Bottom Line: There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.The scripted code status explanation did not significantly impact the composite score.Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.

View Article: PubMed Central - PubMed

Affiliation: Cleveland Clinic, Cleveland, OH, USA.

ABSTRACT

Objectives: There is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.

Methods: This was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.

Results: The composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.

Conclusion: The scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.

Practice implications: Standardized discussion of code status and training in communication of end-of-life care merit further research.

No MeSH data available.


CONSORT flow diagram depicting flow of patients.
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Figure 0001: CONSORT flow diagram depicting flow of patients.

Mentions: Eligible participants were identified from the daily admission log. Patients aged 18 years or older admitted to the regular nursing floor were eligible for the study. Patients who were admitted to the intensive care unit (ICU), had an altered mental status or were unable to consent were excluded from enrollment. The study investigators interviewed the eligible participants within 48 hours of their admission. Study design is summarized in the CONSORT flow diagram (Fig. 1). Three hundred and forty-six patients admitted to the regular nursing floor were screened for eligibility. Ten patients were excluded either due to being non-English speaking (5) or for refusal to participate (5). The remaining 336 patients were sequentially randomized using a unified patient log with a 1:1 allocation ratio to control (170) or intervention arm (166). Ten patients were excluded due to potential depressive symptomatology based on PHQ-2 screening (six in the control arm, four in the intervention arm) (21). Data were incomplete for 26 patients and, consequently, data from 150 patients were analyzed in each arm.


Use of a standardized code status explanation by residents among hospitalized patients.

Mittal K, Sharma K, Dangayach N, Raval D, Leung K, George S, Abraham G - J Community Hosp Intern Med Perspect (2014)

CONSORT flow diagram depicting flow of patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3992358&req=5

Figure 0001: CONSORT flow diagram depicting flow of patients.
Mentions: Eligible participants were identified from the daily admission log. Patients aged 18 years or older admitted to the regular nursing floor were eligible for the study. Patients who were admitted to the intensive care unit (ICU), had an altered mental status or were unable to consent were excluded from enrollment. The study investigators interviewed the eligible participants within 48 hours of their admission. Study design is summarized in the CONSORT flow diagram (Fig. 1). Three hundred and forty-six patients admitted to the regular nursing floor were screened for eligibility. Ten patients were excluded either due to being non-English speaking (5) or for refusal to participate (5). The remaining 336 patients were sequentially randomized using a unified patient log with a 1:1 allocation ratio to control (170) or intervention arm (166). Ten patients were excluded due to potential depressive symptomatology based on PHQ-2 screening (six in the control arm, four in the intervention arm) (21). Data were incomplete for 26 patients and, consequently, data from 150 patients were analyzed in each arm.

Bottom Line: There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.The scripted code status explanation did not significantly impact the composite score.Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.

View Article: PubMed Central - PubMed

Affiliation: Cleveland Clinic, Cleveland, OH, USA.

ABSTRACT

Objectives: There is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.

Methods: This was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.

Results: The composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.

Conclusion: The scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.

Practice implications: Standardized discussion of code status and training in communication of end-of-life care merit further research.

No MeSH data available.