Clinical question: Does the use of a CPR decision support video impact patients’ code status preferences?
Background: Discussions about cardiopulmonary resuscitation are an important aspect of inpatient care but may be difficult to complete for several reasons, including poor patient understanding of the CPR process and its expected outcomes. This study sought to evaluate the impact of a CPR decision support video on patient CPR preferences.
Study design: Nonblinded randomized controlled trial.
Setting: General medicine wards at the Minneapolis Veterans Affairs from Sept. 28, 2015, to Oct. 23, 2015.
Synopsis: One hundred and nineteen patients older than 65 were randomized to receive standard care plus viewing a CPR decision support video or standard care alone. The primary outcome was patient code status preference. Patients completed a survey assessing trust in their care team.
Among the patients who viewed the video, 37% chose full code, compared with 71% of patients in the usual care arm. Patients who viewed the video were more likely to choose DNR/DNI (56%, compared with 17% in the control group). There was no significant difference in patient trust of the care team.
Study conclusions are limited by a study population consisting predominantly of white males. Though the study was randomized, it was not blinded.
Bottom line: A CPR decision support video led to a decrease in full code preference and an increase in DNR/DNI preference among hospitalized patients.
Citation: Merino AM et al. A randomized controlled trial of a CPR decision support video for patients admitted to the general medicine service. J Hosp Med. 2017;12(9):700-4.
Dr. Rodriguez is a hospitalist and a clinical informatics fellow, Beth Israel Deaconess Medical Center, Boston.