Journal of General Internal Medicine

, Volume 10, Issue 4, pp 179–186

Preferences for cardiopulmonary resuscitation

Physician-patient agreement and hospital resource use

Authors

  • Joan M. Teno
    • The Center for the Evaluative Clinical SciencesDartmouth Medical School
  • Rosemarie B. Hakim
    • the ICU Research UnitGeorge Washington University Medical Center
  • William A. Knaus
    • the ICU Research UnitGeorge Washington University Medical Center
  • Neil S. Wenger
    • the University of California at Los Angeles Medical Center
  • Russell S. Phillips
    • Beth Israel Hospital
  • Albert W. Wu
    • Johns Hopkins University Health Services Research and Development Center
  • Peter Layde
    • the Medical College of Wisconsin
  • Alfred F. ConnorsJr.
    • Cleveland MetroHealth Medical Center
  • Neal V. Dawson
    • Cleveland MetroHealth Medical Center
  • Joanne Lynn
    • The Center for the Evaluative Clinical SciencesDartmouth Medical School
  • the SUPPORT Investigators
Original Articles

DOI: 10.1007/BF02600252

Cite this article as:
Teno, J.M., Hakim, R.B., Knaus, W.A. et al. J Gen Intern Med (1995) 10: 179. doi:10.1007/BF02600252

Abstract

OBJECTIVE: To describe the association between hospital resource utilization and physicians’ knowledge of patient preferences for cardiopulmonary resuscitation (CPR) among seriously ill hospitalized adult patients.

DESIGN: Prospective cohort study.

SETTING: Five U.S. academic medical centers, 1989–1991.

PATIENTS: A sample of 2,636 patients with self- or surrogate interviews and matching physician interviews describing patient preferences for CPR, from a cohort of 4,301 patients with life-threatening illnesses enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

MEASURES: Patient, surrogate, and physician reports of preferences for resuscitation, and resource use derived from the Therapeutic Intensity Scoring System and hospital length of stay, converted into 1990 dollars.

RESULTS: Nearly one-third of the patients preferred to forge resuscitation. Of the 2,636 paired physician—patient answers, nearly one-third did not agree about preferences for resuscitation. The physicians’ views of the patients’ preferences and those preferences themselves were both associated with resource use. Standardized adjusted hospital resource consumption, expressed as average cost in dollars during the enrollment hospitalization, was lowest when the physician agreed with the patient preference for a do-not-resuscitate order ($20,527), and highest when the patient did not have a preference and the physician believed the patient wanted resuscitation in the case of a cardiopulmonary arrest ($34,829) Hospital resource use was intermediate when patient—physician pairs evidenced either lack of agreement or communication, or awareness of options about resuscitation.

CONCLUSIONS: Both physician and patient preferences for CPR influence total hospital resource consumption. Physician misunderstanding of patient preferences to forgo CPR was associated with increased use of hospital resources, and could have led to a course of care at odds with patients’ expressed preferences in the event of cardiac arrest. Increasing physicians’ knowledge of patient preferences, and increasing communication to help patients understand that options foi medical care that include forgoing resuscitation efforts, might reduce hospital expenditures for the seriously ill.

Key words

decision makingphysician-patient relationsresuscitation orderspatient preferencesresource utilization

Copyright information

© Society of General Internal Medicine 1995