If asked, hospitalized patients will choose whether to receive life-sustaining therapies

BACKGROUND: No national policy requires health care providers to discuss with hospitalized patients whether the latter would want cardiopulmonary resuscitation (CPR) or mechanical ventilation (MV) in the event of cardiopulmonary failure. OBJECTIVE: To determine whether hospitalized patients are willing to discuss end-of-life issues and choose whether to receive CPR and MV. DESIGN: Prospective randomized trial. PARTICIPANTS: 297 patients admitted to the medicine service of a 350-bed community teaching hospital. INTERVENTION: Patients were randomized to receive routine care or a scripted intervention, delivered by research physicians, that included detailed information about CPR, MV, and advance directives. MEASUREMENTS: Number of patients who welcomed the scripted intervention number who chose to receive or reject CPR/MV, and number of advance directives created during hospitalization. RESULTS: Of the 297 patients studied, 136 were in the intervention group and 161 were in the control group. Baseline characteristics and severity of illness were similar in the 2 groups. Of the 136 patients in the intervention group, 133 (98%) willingly discussed CPR and mechanical ventilation, and 112 (82%) found the information useful. One hundred and twenty-five (92%) clarified their preferences regarding CPR and MV after receiving the intervention; of the 48 patients who were initially documented as wanting CPR/MV, 3 requested no CPR/MV after the intervention. Of the 87 patients in the intervention group who had no documentation of code status on admission, 5 asked for no CPR/MV. Of the 161 patients in the control group, 55 had documentation of their code status on admission. Of the 106 patients without documentation, 6 were later documented to receive no CPR/MV. Thirteen of the 102 patients who had no advance directive on admission created one after the intervention, whereas only I of the 128 patients in the control group did so (P < .001). CONCLUSIONS: Patients are willing to discuss and give informed consent for CPR and mechanical ventilation early in hospitalization. Only a minority drafted advance directives during hospitalization. Larger studies that include patients at other centers are required to determine whether these findings are reproducible and whether this approach is clinically feasible.