Cardiopulmonary Resuscitation on Television — Miracles and Misinformation

Diem, Susan J.; Lantos, John D.; Tulsky, James A.

doi:10.1056/nejm199606133342406

Cited by 461 publications

(159 citation statements)

References 26 publications

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“…Conversely, a patient who wants CPR, believing that she would have a 70% chance of full recovery, is in danger of being subjected to an intervention she might not want if she understood the true likelihood of success. 27 Our patients generally believed that they would have a 70% chance of recovery to hospital discharge after CPR, which is remarkably close to the survival rate of CPR in television programs, 28 but far above that predicted by their physicians and far above the actual survival rate (9-16%). 29,30 Other studies have also reported that patients do not understand terms commonly used in living wills 11 and do not have a good understanding of CPR.…”

Section: Discussionsupporting

confidence: 50%

Patient knowledge and physician predictions of treatment preferences after discussion of advance directives

et al. 1998

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OBJECTIVE:To determine patient knowledge about life-sustaining treatments and physician understanding of patient preferences for proxies and treatments after outpatient discussions about advance directives. DESIGN:Cross-sectional interview-based and questionnairebased survey. SETTING:Two university general internal medicine practices, two Department of Veterans Affairs general internal medicine practices, and one university-based geriatrics practice, in two different cities. PATIENTS:Fifty-six patients of primary care internists. INTERVENTION:Physicians discussed "advance directives" (ADs) with one randomly selected patient during an outpatient visit. MEASUREMENTS AND MAIN RESULTS:

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Section: Discussionsupporting

confidence: 50%

Patient knowledge and physician predictions of treatment preferences after discussion of advance directives

et al. 1998

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“…In reality, 56% of patients who require mechanical ventilation for 48 h or more are dead at 1 year, and almost 60% of the survivors require caregiver assistance at 1 year 32 . This, of course, is in stark contrast to the popular representations of life-sustaining treatments 33 . Even among those with a more clinically realistic estimation of the effectiveness of mechanical ventilation, blacks were twice as likely as Hispanics and nonHispanic whites to want a ventilator for life extension of 1 month or 1 week.…”

Section: Discussionmentioning

confidence: 84%

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

et al. 2009

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“…Despite efforts to make discussions regarding CPR and intubation a routine aspect of inpatient care, clinicians are often uncomfortable and may avoid having these discussions. [1][2][3] Ascertainment of patients' wishes for CPR and intubation frequently occur late in their hospitalization, 4-8 sometimes after they have lost decision-making capacity. 9,10 In 1995, the SUPPORT trial found that the majority of orders related to resuscitation were written in the last 3 days of life.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

et al. 2015

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BACKGROUND: Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided. OBJECTIVES: We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers. DESIGN: This was a prospective randomized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston. PARTICIPANTS: One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included. Mean age was 76 and 51 % were women. INTERVENTION: Three-minute video describing CPR and intubation plus verbal communication of participants' preferences to their physicians (intervention) (N=75) or control arm (usual care) (N=75). MAIN MEASURES: The primary outcome was participants' preferences for CPR and intubation (immediately after viewing the video in the intervention arm). Secondary outcomes included: orders to withhold CPR/intubation, documented discussions with providers during hospitalization, and participants' knowledge of CPR/ intubation (five-item test, range 0-5, higher scores indicate greater knowledge). RESULTS: Intervention participants (vs. controls) were more likely not to want CPR (64 % vs. 32 %, p <0.0001) and intubation (72 % vs. 43 %, p<0.0001). Intervention participants (vs. controls) were also more likely to have orders to withhold CPR (57 % vs. 19 %, p<0.0001) and intubation (64 % vs.19 %, p<0.0001) by hospital discharge, documented discussions about their preferences (81 % vs. 43 %, p<0.0001), and higher mean knowledge scores (4.11 vs. 2.45; p<0.0001).CONCLUSIONS: Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers. Trial registration: Clinicaltrials.gov NCT01325519 Registry Name: A prospective randomized trial using video images in advance care planning in seriously ill hospitalized patients.

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Cardiopulmonary Resuscitation on Television — Miracles and Misinformation

Cited by 461 publications

References 26 publications

Patient knowledge and physician predictions of treatment preferences after discussion of advance directives

Patient knowledge and physician predictions of treatment preferences after discussion of advance directives

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients

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