TY - JOUR
T1 - Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients
AU - Stapleton, Renee D.
AU - Ford, Dee W.
AU - Sterba, Katherine R.
AU - Nadig, Nandita R.
AU - Ades, Steven
AU - Back, Anthony L.
AU - Carson, Shannon S.
AU - Cheung, Katharine L.
AU - Ely, Janet
AU - Kross, Erin K.
AU - Macauley, Robert C.
AU - Maguire, Jennifer M.
AU - Marcy, Theodore W.
AU - McEntee, Jennifer J.
AU - Menon, Prema R.
AU - Overstreet, Amanda
AU - Ritchie, Christine S.
AU - Wendlandt, Blair
AU - Ardren, Sara S.
AU - Balassone, Michael
AU - Burns, Stephanie
AU - Choudhury, Summer
AU - Diehl, Sandra
AU - McCown, Ellen
AU - Nielsen, Elizabeth L.
AU - Paul, Sudiptho R.
AU - Rice, Colleen
AU - Taylor, Katherine K.
AU - Engelberg, Ruth A.
N1 - Funding Information:
With immense professional love and gratitude, we wish to acknowledge Dr. Randy Curtis for the crucial role he has selflessly played in this body of work for 15 years. Were it not that this issue of JPSM in honor of him is a surprise, he would have been a co-author of this manuscript. Randy has been an extraordinary mentor, sponsor, coach, and friend, and we are forever grateful that he has made us better academicians, researchers, physicians, and human beings. This work was supported by the National Palliative Care Research Center (grant title “Changing the paradigm of CPR: Exploring Informed Assent”) and the National Institutes of Health (R01AG050698). RDS, DWF, ELN, KKT, and RAE were supported by both the National Palliative Care Research Center and the National Institutes of Health (NIH) for this research. KRS, SD, and EM were supported by the National Palliative Care Research Center for this research. NRN, SSC, KLC, EKK, RCM, JMM, JJE, PRM, AO, CSR, BW, SSA, MB, SB, SC, SRP, and CR were supported by the NIH for this work. SA, ALB, JA, and TWM have nothing to disclose.
Funding Information:
This work was supported by the National Palliative Care Research Center (grant title “Changing the paradigm of CPR: Exploring Informed Assent”) and the National Institutes of Health ( R01AG050698 ).
Publisher Copyright:
© 2022 American Academy of Hospice and Palliative Medicine
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
KW - Code status
KW - cardiopulmonary resuscitation
KW - communication
KW - end-of-life
KW - seriously ill patients
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UR - http://www.scopus.com/inward/citedby.url?scp=85129930717&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2022.03.009
DO - 10.1016/j.jpainsymman.2022.03.009
M3 - Article
C2 - 35595375
AN - SCOPUS:85129930717
SN - 0885-3924
VL - 63
SP - e621-e632
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 6
ER -