, Volume 3, Issue 4, pp 317-321

Discussing cardiopulmonary resuscitation

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Abstract

Decisions about when to perform cardiopulmonary resuscitation (CPR) are frequently made without knowing the wishes of the patient. To evaluate the feasibility of outpatient discussions about CPR, the authors surveyed 22 male and 53 female, mentally competent, ambulatory patients 65 years of age and older. Only 7% of those interviewed had an accurate understanding of what CPR meant before hearing a standardized description. Eighty-seven per cent thought discussions about CPR should take place routinely, but only 3% had previously discussed this issue with their physicians. Seventy per cent felt such discussions should take place during periods of health, and 84% felt their views should be part of the medical record. When asked about three terminal illnesses, a minority of patients wanted CPR: 25% felt CPR was indicated in the presence of irreversible coma, 28% for terminal cancer, and 41% for irreversible heart failure. More patients felt they would request CPR if they had irreversible heart failure than if in a coma (p<0.002) or for terminal cancer (p=0.002). The majority of elderly outpatients have clearly defined opinions about the application of CPR and wish to discuss them with their physicians.

Received from the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory, Boston, Massachusetts. Dr. Bedell is currently at the East Texas Diagnostic Clinic in Palestine, Texas, and Mr. Lilienfeld is attending the University of Chicago School of Medicine, Chicago, Illinois. Data analysis was performed on the PROPHET system, a national computer resource sponsored by the Division of Research Resources.