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Am Fam Physician. 2006;74(11):1946

Patients are more likely to be unhappy with their end-of-life care and to use more health care resources when the care is inconsistent with their previously expressed wishes. Conversations about end-of-life care occur infrequently, and physicians and family members usually are not aware of patients’ preferences about life-prolonging therapy. Studies have shown poor agreement between what patients want and what physicians and family members believe patients want regarding health care. Heyland and associates assessed the views of hospitalized patients and their families about communication and decision making related to cardiopulmonary resuscitation (CPR).

A cross-sectional survey was given to patients older than 55 years who were admitted to one of five tertiary care hospitals. Inclusion criteria were advanced chronic obstructive pulmonary disease, New York Heart Association class IV heart failure or an ejection fraction of 25 percent or less, advanced hepatic cirrhosis, metastatic cancer or stage IV lymphoma, or a minimum expected hospital stay of 72 hours. Studies have shown that patients meeting these inclusion criteria had a 50 percent chance of dying within the next six months. A questionnaire developed in previous studies, which included questions about end-of-life care and CPR communication and decision making, was used in a face-to-face interview with the patients. A family member also was interviewed, if available.

There were 440 patients and 160 family members who agreed to participate in the study. Sixty-one percent of the patients had thought about what treatment they would want if their heart stopped. However, only a few patients could describe two or more components of CPR, and 2.7 percent thought the CPR success rate was less than 10 percent. Only 34 percent of patients had discussed CPR with their physicians, and 37 percent did not want to have the discussion. Patients who believed that end-of-life issues were relevant to them were 5.5 times more likely to want to discuss resuscitation with their physicians. Most patients and their families preferred some form of shared decision making that included family members.

The authors conclude that patients who are hospitalized with a serious illness have a poor understanding of CPR. In addition, they have different preferences for their role in making decisions about CPR. Improving patients’ understanding of CPR and facilitating discussions among patients, families, and physicians may improve communication and decision making about CPR.

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