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Physician understanding of patient resuscitation preferences: insights and clinical implications.
J Am Geriatr Soc 2000; 48(S1):S44-51JA

Abstract

OBJECTIVE

To describe physician understanding of patient preferences concerning cardiopulmonary resuscitation (CPR) and to assess the relationship of physician understanding of patient preferences with do not resuscitate (DNR) orders and in-hospital CPR.

DESIGN

We evaluated physician understanding of patient CPR preference and the association of patient characteristics and physician-patient communication with physician understanding of patient CPR preferences. Among patients preferring to forego CPR, we compared attempted resuscitations and time to receive a DNR order between patients whose preference was understood or misunderstood by their physician.

PATIENTS/SETTING

Seriously ill hospitalized adult patients were enrolled in the Study to Understand Prognoses and Preferences for the Outcomes of Treatments. GENERAL RESULTS: Physicians understood 86% of patient preferences for CPR, but only 46% of patient preferences to forego CPR. Younger patient age, higher physician-estimated quality of life, and higher physician prediction of 6-month survival were independently associated with both physician understanding when a patient preferred to receive CPR and physician misunderstanding when a patient preferred to forego CPR. Physicians who spoke with patients about resuscitation and had longer physician-patient relationships understood patients' preferences to forego CPR more often. Patients whose physicians understood their preference to forego CPR more often received DNR orders, received them earlier, and were significantly less likely to undergo resuscitation.

CONCLUSIONS

Physicians often misunderstand seriously ill, hospitalized patients' resuscitation preferences, especially preferences to forego CPR. Factors associated with misunderstanding suggest that physicians infer patients' preferences without asking the patient. Patients who prefer to forego CPR but whose wishes are not understood by their physician may receive unwanted treatment.

Authors+Show Affiliations

Department of Medicine, UCLA School of Medicine, Los Angeles, California 90095-1736, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10809456

Citation

Wenger, N S., et al. "Physician Understanding of Patient Resuscitation Preferences: Insights and Clinical Implications." Journal of the American Geriatrics Society, vol. 48, no. S1, 2000, pp. S44-51.
Wenger NS, Phillips RS, Teno JM, et al. Physician understanding of patient resuscitation preferences: insights and clinical implications. J Am Geriatr Soc. 2000;48(S1):S44-51.
Wenger, N. S., Phillips, R. S., Teno, J. M., Oye, R. K., Dawson, N. V., Liu, H., ... Lynn, J. (2000). Physician understanding of patient resuscitation preferences: insights and clinical implications. Journal of the American Geriatrics Society, 48(S1), pp. S44-51.
Wenger NS, et al. Physician Understanding of Patient Resuscitation Preferences: Insights and Clinical Implications. J Am Geriatr Soc. 2000;48(S1):S44-51. PubMed PMID: 10809456.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician understanding of patient resuscitation preferences: insights and clinical implications. AU - Wenger,N S, AU - Phillips,R S, AU - Teno,J M, AU - Oye,R K, AU - Dawson,N V, AU - Liu,H, AU - Califf,R, AU - Layde,P, AU - Hakim,R, AU - Lynn,J, PY - 2000/5/16/pubmed PY - 2000/6/8/medline PY - 2000/5/16/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Professional Patient Relationship KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - S44 EP - 51 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 48 IS - S1 N2 - OBJECTIVE: To describe physician understanding of patient preferences concerning cardiopulmonary resuscitation (CPR) and to assess the relationship of physician understanding of patient preferences with do not resuscitate (DNR) orders and in-hospital CPR. DESIGN: We evaluated physician understanding of patient CPR preference and the association of patient characteristics and physician-patient communication with physician understanding of patient CPR preferences. Among patients preferring to forego CPR, we compared attempted resuscitations and time to receive a DNR order between patients whose preference was understood or misunderstood by their physician. PATIENTS/SETTING: Seriously ill hospitalized adult patients were enrolled in the Study to Understand Prognoses and Preferences for the Outcomes of Treatments. GENERAL RESULTS: Physicians understood 86% of patient preferences for CPR, but only 46% of patient preferences to forego CPR. Younger patient age, higher physician-estimated quality of life, and higher physician prediction of 6-month survival were independently associated with both physician understanding when a patient preferred to receive CPR and physician misunderstanding when a patient preferred to forego CPR. Physicians who spoke with patients about resuscitation and had longer physician-patient relationships understood patients' preferences to forego CPR more often. Patients whose physicians understood their preference to forego CPR more often received DNR orders, received them earlier, and were significantly less likely to undergo resuscitation. CONCLUSIONS: Physicians often misunderstand seriously ill, hospitalized patients' resuscitation preferences, especially preferences to forego CPR. Factors associated with misunderstanding suggest that physicians infer patients' preferences without asking the patient. Patients who prefer to forego CPR but whose wishes are not understood by their physician may receive unwanted treatment. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/10809456/Physician_understanding_of_patient_resuscitation_preferences:_insights_and_clinical_implications_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2000&volume=48&issue=S1&spage=S44 DB - PRIME DP - Unbound Medicine ER -