Evolution of Investigating Informed Assent Discussions About CPR in Seriously Ill Patients

Overview

Journal J Pain Symptom Manage

Publisher Elsevier

Specialties Critical Care
Pharmacology
Psychiatry

Date 2022 May 20

PMID 35595375

Authors

Renee D Stapleton

Dee W Ford

Katherine R Sterba

Nandita R Nadig

Steven Ades

Anthony L Back

Shannon S Carson

Katharine L Cheung

Janet Ely

Erin K Kross

Robert C Macauley

Jennifer M Maguire

Theodore W Marcy

Jennifer J McEntee

Prema R Menon

Amanda Overstreet

Christine S Ritchie

Blair Wendlandt

Sara S Ardren

Michael Balassone

Stephanie Burns

Summer Choudhury

Sandra Diehl

Ellen McCown

Elizabeth L Nielsen

Sudiptho R Paul

Colleen Rice

Katherine K Taylor

Ruth A Engelberg

Affiliations

Soon will be listed here.

Abstract

Context: Outcomes after cardiopulmonary resuscitation (CPR) remain poor. We have spent 10 years investigating an "informed assent" (IA) approach to discussing CPR with chronically ill patients/families. IA is a discussion framework whereby patients extremely unlikely to benefit from CPR are informed that unless they disagree, CPR will not be performed because it will not help achieve their goals, thus removing the burden of decision-making from the patient/family, while they retain an opportunity to disagree.

Objectives: Determine the acceptability and efficacy of IA discussions about CPR with older chronically ill patients/families.

Methods: This multi-site research occurred in three stages. Stage I determined acceptability of the intervention through focus groups of patients with advanced COPD or malignancy, family members, and physicians. Stage II was an ambulatory pilot randomized controlled trial (RCT) of the IA discussion. Stage III is an ongoing phase 2 RCT of IA versus attention control in in patients with advanced chronic illness.

Results: Our qualitative work found the IA approach was acceptable to most patients, families, and physicians. The pilot RCT demonstrated feasibility and showed an increase in participants in the intervention group changing from "full code" to "do not resuscitate" within two weeks after the intervention. However, Stages I and II found that IA is best suited to inpatients. Our phase 2 RCT in older hospitalized seriously ill patients is ongoing; results are pending.

Conclusions: IA is a feasible and reasonable approach to CPR discussions in selected patient populations.

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