Conversations About Treatment at the End of Life
Conventional wisdom in medicine maintains that most physicians, certainly those experienced in talking with patients or their proxies about code status, can profoundly influence the outcome of code status discussions. While there may be few if any studies to substantiate the conventional wisdom, there are probably more than a few grains of truth to it. The study by Downar and colleagues1 provides interesting insights into the thoughts and perspectives of patients who have elected either a “full code” (FC) or “do not resuscitate” (DNR) status, enhancing information gleaned from the dearth of earlier studies. Previous observations indicate that the likelihood of a patient opting for a “full code” status drops dramatically when the patient is fully apprised of the prognosis, especially when life expectancy is less than 6 months.2 Also influential in decreasing a patient’s desire for FC status is that the patient understands that cardio-pulmonary resuscitation (CPR) is unlikely to successf ...
- Downar J, Luk T, Sibbald RW, Santini T, et al. Why do patients agree to a “do not resuscitate” or “full code” order?: Perspectives of medical inpatients. JGIM. 2011; vol: pp.
- Weeks JC, Cook EF, O’Day SJ, Peterson LM, et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA. 1998;279:1709–14. CrossRef
- Murphy DJ, Burrows D, Santilli S, Kemp AW, et al. The influence of the probability of survival on patients’ preferences regarding cardiopulmonary resuscitation. N Engl J Med. 1994;330:545–9. CrossRef
- Christakis NA. Death foretold: prophecy and prognosis in medical care. University of Chicago Press. 1999.
- Fins JJ, Miller FG, Acres CA, et al. End-of-life decision making in the hospital: current practices and future prospects. J Pain Symptom Manage. 1999;17:6–15. CrossRef
- Wanzer SH, Adelstein SJ, Federman DD, Cassel CK, et al. The physician’s responsibility toward hopelessly ill patients—a second look. N Engl J Med. 1989;320:844–9. CrossRef
- Conversations About Treatment at the End of Life
Journal of General Internal Medicine
Volume 26, Issue 6 , pp 568-569
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- 1. Bioethics Program, Department of Internal Medicine, University of California, Davis, 4150 V Street, PSSB Suite 2500, Sacramento, CA, 95817, USA
- 2. Departments of Internal Medicine and Sociology, University of California, Davis, 4150 V Street, PSSB Suite 2500, Sacramento, CA, 95817, USA