TY - JOUR
T1 - Preferences for cardiopulmonary resuscitation among patients 80 years or older
T2 - 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
N1 - Funding Information:
This research was supported by the Robert Wood Johnson Foundation. The opinions and findings contained in this manuscript are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees. Ms. O'Donnell was supported by the American Federation of Aging Research Medical Student Geriatric Scholar Program. Dr. Hamel was supported by a Career Development Award from the National Institute on Aging (K08 AG0075–02) and the Paul Beeson Physician Faculty Scholars in Aging Research Program.
PY - 2003
Y1 - 2003
N2 - Objective: To describe 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 and 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.
AB - Objective: To describe 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 and 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.
KW - Aged
KW - Cardiopulmonary resuscitation
KW - Decision making
KW - Preferences
UR - http://www.scopus.com/inward/record.url?scp=0038147387&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0038147387&partnerID=8YFLogxK
U2 - 10.1016/S1525-8610(04)70323-0
DO - 10.1016/S1525-8610(04)70323-0
M3 - Article
C2 - 12854987
AN - SCOPUS:0038147387
SN - 1525-8610
VL - 4
SP - 139
EP - 144
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -
