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Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians.

Abstract

OBJECTIVE

To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians' perceptions of their patients' preferences and agreement between patients' and physicians' preferences, estimation of prognosis, and assessment of quality of life.

DESIGN

Prospective cohort study.

SETTING

Four academic hospitals.

PARTICIPANTS

Patients 80 years or older hospitalized between January 1993 and November 1994.

MEASUREMENTS

Detailed clinical data were collected by chart review and interview. Patients and physicians were interviewed to determine their preferences for cardiopulmonary resuscitation (CPR). Agreement between patients and physicians was assessed using the kappa statistic, which measures agreement beyond chance.

RESULTS

Of the 1266 patients studied, their median age was 85 years, and 61% were female. The majority (55%) of the 1010 patients with CPR preference information available desired CPR. Compared with patients, fewer physicians wanted CPR (36%) if they were in their patients' condition. Agreement between patients' preferences and physicians' perceptions of these preferences was low (absolute agreement 63%, kappa = 0.21). Agreement was better between physicians' perceptions of patients' preferences and physicians' desire for themselves if they were in their patients' condition (66%, kappa = 0.36). Agreement between patients' and physicians' estimates of survival was only slight (46%, kappa = 0.10). The majority of the disagreement occurred when the physician's prognostic estimate was worse than the patient's.

CONCLUSIONS

The majority of hospitalized patients 80 years older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians' estimates of patients' prognoses were less optimistic than patients' estimates, raising the possibility that physicians' knowledge of older patients' poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older.

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  • Authors+Show Affiliations

    ,

    Washington University School of Medicine, USA.

    , , , ,

    Source

    MeSH

    Academic Medical Centers
    Activities of Daily Living
    Age Factors
    Aged
    Aged, 80 and over
    Attitude of Health Personnel
    Attitude to Health
    Cardiopulmonary Resuscitation
    Choice Behavior
    Female
    Geriatric Assessment
    Humans
    Inpatients
    Male
    Medical Futility
    Patient Education as Topic
    Physicians
    Prognosis
    Prospective Studies
    Quality of Life
    Surveys and Questionnaires
    United States

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12854987

    Citation

    O'Donnell, Heather, et al. "Preferences for Cardiopulmonary Resuscitation Among Patients 80 Years or Older: the Views of Patients and Their Physicians." Journal of the American Medical Directors Association, vol. 4, no. 3, 2003, pp. 139-44.
    O'Donnell H, Phillips RS, Wenger N, et al. Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians. J Am Med Dir Assoc. 2003;4(3):139-44.
    O'Donnell, H., Phillips, R. S., Wenger, N., Teno, J., Davis, R. B., & Hamel, M. B. (2003). Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians. Journal of the American Medical Directors Association, 4(3), pp. 139-44.
    O'Donnell H, et al. Preferences for Cardiopulmonary Resuscitation Among Patients 80 Years or Older: the Views of Patients and Their Physicians. J Am Med Dir Assoc. 2003;4(3):139-44. PubMed PMID: 12854987.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Preferences for cardiopulmonary resuscitation among patients 80 years or older: the views of patients and their physicians. AU - O'Donnell,Heather, AU - Phillips,Russell S, AU - Wenger,Neil, AU - Teno,Joan, AU - Davis,Roger B, AU - Hamel,Mary Beth, PY - 2003/7/12/pubmed PY - 2003/7/26/medline PY - 2003/7/12/entrez SP - 139 EP - 44 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 4 IS - 3 N2 - OBJECTIVE: To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians' perceptions of their patients' preferences and agreement between patients' and physicians' preferences, estimation of prognosis, and assessment of quality of life. DESIGN: Prospective cohort study. SETTING: Four academic hospitals. PARTICIPANTS: Patients 80 years or older hospitalized between January 1993 and November 1994. MEASUREMENTS: Detailed clinical data were collected by chart review and interview. Patients and physicians were interviewed to determine their preferences for cardiopulmonary resuscitation (CPR). Agreement between patients and physicians was assessed using the kappa statistic, which measures agreement beyond chance. RESULTS: Of the 1266 patients studied, their median age was 85 years, and 61% were female. The majority (55%) of the 1010 patients with CPR preference information available desired CPR. Compared with patients, fewer physicians wanted CPR (36%) if they were in their patients' condition. Agreement between patients' preferences and physicians' perceptions of these preferences was low (absolute agreement 63%, kappa = 0.21). Agreement was better between physicians' perceptions of patients' preferences and physicians' desire for themselves if they were in their patients' condition (66%, kappa = 0.36). Agreement between patients' and physicians' estimates of survival was only slight (46%, kappa = 0.10). The majority of the disagreement occurred when the physician's prognostic estimate was worse than the patient's. CONCLUSIONS: The majority of hospitalized patients 80 years older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians' estimates of patients' prognoses were less optimistic than patients' estimates, raising the possibility that physicians' knowledge of older patients' poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older. SN - 1525-8610 UR - https://www.unboundmedicine.com/medline/citation/12854987/Preferences_for_cardiopulmonary_resuscitation_among_patients_80_years_or_older:_the_views_of_patients_and_their_physicians_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(04)70323-0 DB - PRIME DP - Unbound Medicine ER -