Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use

Joan Teno, Rosemarie B. Hakim, William A. Knaus, Neil S. Wenger, Russell S. Phillips, Albert W. Wu, Peter Layde, Alfred F. Connors, Neal V. Dawson, Joanne Lynn

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

OBJECTIVE: To describe the association between hospital resource utilization and physicians' knowledge of patient preferences for cardiopulmonary resuscitation (CPR) among seriously ill hospitalized adult patients. DESIGN: Prospective cohort study. SETTING: Five U.S. academic medical centers, 1989-1991. PATIENTS: A sample of 2,636 patients with self- or surrogate interviews and matching physician interviews describing patient preferences for CPR, from a cohort of 4,301 patients with life-threatening illnesses enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). MEASURES: Patient, surrogate, and physician reports of preferences for resuscitation, and resource use derived from the Therapeutic Intensity Scoring System and hospital length of stay, converted into 1990 dollars. RESULTS: Nearly one-third of the patients preferred to forge resuscitation. Of the 2,636 paired physician-patient answers, nearly one-third did not agree about preferences for resuscitation. The physicians' views of the patients' preferences and those preferences themselves were both associated with resource use. Standardized adjusted hospital resource consumption, expressed as average cost in dollars during the enrollment hospitalization, was lowest when the physician agreed with the patient preference for a do-not-resuscitate order ($20,527), and highest when the patient did not have a preference and the physician believed the patient wanted resuscitation in the case of a cardiopulmonary arrest ($34,829) Hospital resource use was intermediate when patient-physician pairs evidenced either lack of agreement or communication, or awareness of options about resuscitation. CONCLUSIONS: Both physician and patient preferences for CPR influence total hospital resource consumption. Physician misunderstanding of patient preferences to forgo CPR was associated with increased use of hospital resources, and could have led to a course of care at odds with patients' expressed preferences in the event of cardiac arrest. Increasing physicians' knowledge of patient preferences, and increasing communication to help patients understand that options foi medical care that include forgoing resuscitation efforts, might reduce hospital expenditures for the seriously ill.

Original languageEnglish (US)
Pages (from-to)179-186
Number of pages8
JournalJournal of general internal medicine
Volume10
Issue number4
DOIs
StatePublished - Apr 1 1995
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Patient Preference
Physicians
Resuscitation
Heart Arrest
Length of Stay
Communication
Resuscitation Orders
Interviews
Therapeutic Uses
Health Expenditures
Hospitalization
Cohort Studies
Prospective Studies
Costs and Cost Analysis

Keywords

  • decision making
  • patient preferences
  • physician-patient relations
  • resource utilization
  • resuscitation orders

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use. / Teno, Joan; Hakim, Rosemarie B.; Knaus, William A.; Wenger, Neil S.; Phillips, Russell S.; Wu, Albert W.; Layde, Peter; Connors, Alfred F.; Dawson, Neal V.; Lynn, Joanne.

In: Journal of general internal medicine, Vol. 10, No. 4, 01.04.1995, p. 179-186.

Research output: Contribution to journalArticle

Teno, J, Hakim, RB, Knaus, WA, Wenger, NS, Phillips, RS, Wu, AW, Layde, P, Connors, AF, Dawson, NV & Lynn, J 1995, 'Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use', Journal of general internal medicine, vol. 10, no. 4, pp. 179-186. https://doi.org/10.1007/BF02600252
Teno, Joan ; Hakim, Rosemarie B. ; Knaus, William A. ; Wenger, Neil S. ; Phillips, Russell S. ; Wu, Albert W. ; Layde, Peter ; Connors, Alfred F. ; Dawson, Neal V. ; Lynn, Joanne. / Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use. In: Journal of general internal medicine. 1995 ; Vol. 10, No. 4. pp. 179-186.
@article{401c70688244496488216ac7f315ddd9,
title = "Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use",
abstract = "OBJECTIVE: To describe the association between hospital resource utilization and physicians' knowledge of patient preferences for cardiopulmonary resuscitation (CPR) among seriously ill hospitalized adult patients. DESIGN: Prospective cohort study. SETTING: Five U.S. academic medical centers, 1989-1991. PATIENTS: A sample of 2,636 patients with self- or surrogate interviews and matching physician interviews describing patient preferences for CPR, from a cohort of 4,301 patients with life-threatening illnesses enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). MEASURES: Patient, surrogate, and physician reports of preferences for resuscitation, and resource use derived from the Therapeutic Intensity Scoring System and hospital length of stay, converted into 1990 dollars. RESULTS: Nearly one-third of the patients preferred to forge resuscitation. Of the 2,636 paired physician-patient answers, nearly one-third did not agree about preferences for resuscitation. The physicians' views of the patients' preferences and those preferences themselves were both associated with resource use. Standardized adjusted hospital resource consumption, expressed as average cost in dollars during the enrollment hospitalization, was lowest when the physician agreed with the patient preference for a do-not-resuscitate order ($20,527), and highest when the patient did not have a preference and the physician believed the patient wanted resuscitation in the case of a cardiopulmonary arrest ($34,829) Hospital resource use was intermediate when patient-physician pairs evidenced either lack of agreement or communication, or awareness of options about resuscitation. CONCLUSIONS: Both physician and patient preferences for CPR influence total hospital resource consumption. Physician misunderstanding of patient preferences to forgo CPR was associated with increased use of hospital resources, and could have led to a course of care at odds with patients' expressed preferences in the event of cardiac arrest. Increasing physicians' knowledge of patient preferences, and increasing communication to help patients understand that options foi medical care that include forgoing resuscitation efforts, might reduce hospital expenditures for the seriously ill.",
keywords = "decision making, patient preferences, physician-patient relations, resource utilization, resuscitation orders",
author = "Joan Teno and Hakim, {Rosemarie B.} and Knaus, {William A.} and Wenger, {Neil S.} and Phillips, {Russell S.} and Wu, {Albert W.} and Peter Layde and Connors, {Alfred F.} and Dawson, {Neal V.} and Joanne Lynn",
year = "1995",
month = "4",
day = "1",
doi = "10.1007/BF02600252",
language = "English (US)",
volume = "10",
pages = "179--186",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "4",

}

TY - JOUR

T1 - Preferences for cardiopulmonary resuscitation - Physician-patient agreement and hospital resource use

AU - Teno, Joan

AU - Hakim, Rosemarie B.

AU - Knaus, William A.

AU - Wenger, Neil S.

AU - Phillips, Russell S.

AU - Wu, Albert W.

AU - Layde, Peter

AU - Connors, Alfred F.

AU - Dawson, Neal V.

AU - Lynn, Joanne

PY - 1995/4/1

Y1 - 1995/4/1

N2 - OBJECTIVE: To describe the association between hospital resource utilization and physicians' knowledge of patient preferences for cardiopulmonary resuscitation (CPR) among seriously ill hospitalized adult patients. DESIGN: Prospective cohort study. SETTING: Five U.S. academic medical centers, 1989-1991. PATIENTS: A sample of 2,636 patients with self- or surrogate interviews and matching physician interviews describing patient preferences for CPR, from a cohort of 4,301 patients with life-threatening illnesses enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). MEASURES: Patient, surrogate, and physician reports of preferences for resuscitation, and resource use derived from the Therapeutic Intensity Scoring System and hospital length of stay, converted into 1990 dollars. RESULTS: Nearly one-third of the patients preferred to forge resuscitation. Of the 2,636 paired physician-patient answers, nearly one-third did not agree about preferences for resuscitation. The physicians' views of the patients' preferences and those preferences themselves were both associated with resource use. Standardized adjusted hospital resource consumption, expressed as average cost in dollars during the enrollment hospitalization, was lowest when the physician agreed with the patient preference for a do-not-resuscitate order ($20,527), and highest when the patient did not have a preference and the physician believed the patient wanted resuscitation in the case of a cardiopulmonary arrest ($34,829) Hospital resource use was intermediate when patient-physician pairs evidenced either lack of agreement or communication, or awareness of options about resuscitation. CONCLUSIONS: Both physician and patient preferences for CPR influence total hospital resource consumption. Physician misunderstanding of patient preferences to forgo CPR was associated with increased use of hospital resources, and could have led to a course of care at odds with patients' expressed preferences in the event of cardiac arrest. Increasing physicians' knowledge of patient preferences, and increasing communication to help patients understand that options foi medical care that include forgoing resuscitation efforts, might reduce hospital expenditures for the seriously ill.

AB - OBJECTIVE: To describe the association between hospital resource utilization and physicians' knowledge of patient preferences for cardiopulmonary resuscitation (CPR) among seriously ill hospitalized adult patients. DESIGN: Prospective cohort study. SETTING: Five U.S. academic medical centers, 1989-1991. PATIENTS: A sample of 2,636 patients with self- or surrogate interviews and matching physician interviews describing patient preferences for CPR, from a cohort of 4,301 patients with life-threatening illnesses enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). MEASURES: Patient, surrogate, and physician reports of preferences for resuscitation, and resource use derived from the Therapeutic Intensity Scoring System and hospital length of stay, converted into 1990 dollars. RESULTS: Nearly one-third of the patients preferred to forge resuscitation. Of the 2,636 paired physician-patient answers, nearly one-third did not agree about preferences for resuscitation. The physicians' views of the patients' preferences and those preferences themselves were both associated with resource use. Standardized adjusted hospital resource consumption, expressed as average cost in dollars during the enrollment hospitalization, was lowest when the physician agreed with the patient preference for a do-not-resuscitate order ($20,527), and highest when the patient did not have a preference and the physician believed the patient wanted resuscitation in the case of a cardiopulmonary arrest ($34,829) Hospital resource use was intermediate when patient-physician pairs evidenced either lack of agreement or communication, or awareness of options about resuscitation. CONCLUSIONS: Both physician and patient preferences for CPR influence total hospital resource consumption. Physician misunderstanding of patient preferences to forgo CPR was associated with increased use of hospital resources, and could have led to a course of care at odds with patients' expressed preferences in the event of cardiac arrest. Increasing physicians' knowledge of patient preferences, and increasing communication to help patients understand that options foi medical care that include forgoing resuscitation efforts, might reduce hospital expenditures for the seriously ill.

KW - decision making

KW - patient preferences

KW - physician-patient relations

KW - resource utilization

KW - resuscitation orders

UR - http://www.scopus.com/inward/record.url?scp=0028948953&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028948953&partnerID=8YFLogxK

U2 - 10.1007/BF02600252

DO - 10.1007/BF02600252

M3 - Article

C2 - 7790978

AN - SCOPUS:0028948953

VL - 10

SP - 179

EP - 186

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 4

ER -