Patients who want their family and physician to make resuscitation decisions for them: Observations from support and help

Christina M. Puchalski, Zhensbao Zhong, Michelle M. Jacobs, Ellen Fox, Joanne Lynn, Joan Harrold, Anthony Galanos, Russell S. Phillips, Robert Califf, Joan Teno

Research output: Contribution to journalArticle

179 Citations (Scopus)

Abstract

OBJECTIVE: To determine the extent to which older or seriously ill inpatients would prefer to have their family and physician make resuscitation decisions for them rather than having their own stated preferences followed if they were unable to decide themselves. DESIGN: Analysis of existing data from the Hospitalized Elderly Longitudinal Project (HELP) and the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). SETTING: Five teaching hospitals in the United States. PARTICIPANTS: 2203 seriously ill adult inpatients (SUPPORT) and 1226 older inpatients (HELP) who expressed preferences about resuscitation and about advance decision-making. MEASURES: We used a logistic regression model to determine which factors predicted preferences for family and physician decision-making. RESULTS: Of the 513 HELP patients in this analysis, 363 (70.8%) would prefer to have their family and physician make resuscitation decisions for them whereas 29.2% would prefer to have their own stated preferences followed if they were to lose decision-making capacity. Of the 646 SUPPORT patients, 504 (78.0%) would prefer to have their family and physician decide and 22.0% would prefer to have their advance preferences followed. Independent predictors of preference for family and physician decision-making included not wanting to be resuscitated and having a surrogate decision-maker. CONCLUSIONS: Most inpatients who are older or have serious illnesses would not want their stated resuscitation preferences followed if they were to lose decision-making capacity. Most patients in both groups would prefer that their family and physician make resuscitation decisions for them. These results underscore the need to understand resuscitation preferences within a broader context of patient values.

Original languageEnglish (US)
Pages (from-to)S84-S90
JournalJournal of the American Geriatrics Society
Volume48
Issue numberS1
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

Fingerprint

Resuscitation Orders
Family Physicians
Decision Making
Inpatients
Resuscitation
Logistic Models
Teaching Hospitals
Longitudinal Studies

Keywords

  • CPR
  • decision-making
  • do-not-resuscitate
  • functional status
  • surrogate

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Patients who want their family and physician to make resuscitation decisions for them : Observations from support and help. / Puchalski, Christina M.; Zhong, Zhensbao; Jacobs, Michelle M.; Fox, Ellen; Lynn, Joanne; Harrold, Joan; Galanos, Anthony; Phillips, Russell S.; Califf, Robert; Teno, Joan.

In: Journal of the American Geriatrics Society, Vol. 48, No. S1, 01.01.2000, p. S84-S90.

Research output: Contribution to journalArticle

Puchalski, Christina M. ; Zhong, Zhensbao ; Jacobs, Michelle M. ; Fox, Ellen ; Lynn, Joanne ; Harrold, Joan ; Galanos, Anthony ; Phillips, Russell S. ; Califf, Robert ; Teno, Joan. / Patients who want their family and physician to make resuscitation decisions for them : Observations from support and help. In: Journal of the American Geriatrics Society. 2000 ; Vol. 48, No. S1. pp. S84-S90.
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AU - Puchalski, Christina M.

AU - Zhong, Zhensbao

AU - Jacobs, Michelle M.

AU - Fox, Ellen

AU - Lynn, Joanne

AU - Harrold, Joan

AU - Galanos, Anthony

AU - Phillips, Russell S.

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N2 - OBJECTIVE: To determine the extent to which older or seriously ill inpatients would prefer to have their family and physician make resuscitation decisions for them rather than having their own stated preferences followed if they were unable to decide themselves. DESIGN: Analysis of existing data from the Hospitalized Elderly Longitudinal Project (HELP) and the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). SETTING: Five teaching hospitals in the United States. PARTICIPANTS: 2203 seriously ill adult inpatients (SUPPORT) and 1226 older inpatients (HELP) who expressed preferences about resuscitation and about advance decision-making. MEASURES: We used a logistic regression model to determine which factors predicted preferences for family and physician decision-making. RESULTS: Of the 513 HELP patients in this analysis, 363 (70.8%) would prefer to have their family and physician make resuscitation decisions for them whereas 29.2% would prefer to have their own stated preferences followed if they were to lose decision-making capacity. Of the 646 SUPPORT patients, 504 (78.0%) would prefer to have their family and physician decide and 22.0% would prefer to have their advance preferences followed. Independent predictors of preference for family and physician decision-making included not wanting to be resuscitated and having a surrogate decision-maker. CONCLUSIONS: Most inpatients who are older or have serious illnesses would not want their stated resuscitation preferences followed if they were to lose decision-making capacity. Most patients in both groups would prefer that their family and physician make resuscitation decisions for them. These results underscore the need to understand resuscitation preferences within a broader context of patient values.

AB - OBJECTIVE: To determine the extent to which older or seriously ill inpatients would prefer to have their family and physician make resuscitation decisions for them rather than having their own stated preferences followed if they were unable to decide themselves. DESIGN: Analysis of existing data from the Hospitalized Elderly Longitudinal Project (HELP) and the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). SETTING: Five teaching hospitals in the United States. PARTICIPANTS: 2203 seriously ill adult inpatients (SUPPORT) and 1226 older inpatients (HELP) who expressed preferences about resuscitation and about advance decision-making. MEASURES: We used a logistic regression model to determine which factors predicted preferences for family and physician decision-making. RESULTS: Of the 513 HELP patients in this analysis, 363 (70.8%) would prefer to have their family and physician make resuscitation decisions for them whereas 29.2% would prefer to have their own stated preferences followed if they were to lose decision-making capacity. Of the 646 SUPPORT patients, 504 (78.0%) would prefer to have their family and physician decide and 22.0% would prefer to have their advance preferences followed. Independent predictors of preference for family and physician decision-making included not wanting to be resuscitated and having a surrogate decision-maker. CONCLUSIONS: Most inpatients who are older or have serious illnesses would not want their stated resuscitation preferences followed if they were to lose decision-making capacity. Most patients in both groups would prefer that their family and physician make resuscitation decisions for them. These results underscore the need to understand resuscitation preferences within a broader context of patient values.

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