Patient-reported and clinician-ordered resuscitation preferences were discordant in 20% of patients hospitalized with acute decompensated heart failure, a recent study reports.1 “We anticipated some discordance, but the proportion that had discordant preferences was higher than I would have expected,” says Shannon Dunlay, MD, one of the study’s authors.
Assessment of preferences for CPR typically is part of the intake process at the time of hospital admission. “We wondered how often patient-reported and clinician-documented orders for resuscitation were the same or different,” says Dunlay, a practicing cardiologist and an associate professor of medicine at Mayo Clinic in Rochester, MN. The study’s key findings include the following:
• Of 400 patients, 213 stated their resuscitation preference as full code, 166 do not resuscitate (DNR), and 21 were unsure.
• In comparison, clinician-ordered resuscitation status was full code in 263 patients, DNR in 133, and not documented in four.
• Patients who indicated a different resuscitation preference than what was ordered by their clinical team were less likely to have an advance directive.
“Patients who have thought about their wishes and documented them in the form of an advance directive may be more likely to have those wishes easily conveyed to the clinical team,” suggests Dunlay.
• When patient-reported and clinician-ordered resuscitation preferences didn’t match, a longer hospital stay was more likely.
“This suggests that patients with discordant preferences may experience more complicated hospitalizations,” says Dunlay.
Additional research is needed on the reasons for the inconsistencies, says Dunlay: “It would be of interest to understand if it were due to lack of communication, confusion, indecision, or other factors.”
1. Young KA, Wordingham SE, Strand JJ, et al. Discordance of patient-reported and clinician-ordered resuscitation status in patients hospitalized with acute decompensated heart failure. J Pain Symptom Manage 2017; 53(4):745-750.
• Shannon Dunlay, MD, Associate Professor of Medicine, Mayo Clinic, Rochester, MN. Phone: (507) 284-8087. Email: Dunlay.Shannon@mayo.edu.