Discussing preferences for cardiopulmonary resuscitation: what do resident physicians and their hospitalized patients think was decided?

OBJECTIVE

To explore the ways in which seriously ill hospitalized patients, their family members and physicians interpret the discussion of the patient's preferences for cardiopulmonary resuscitation (CPR).

METHODS

Resident physicians, their patients, and family members were interviewed following a discussion regarding preferences for CPR. We sought the participants' perceptions of the resulting decision, examined how often these interpretations differed, and explored the communicative factors underlying discrepancies when they occurred.

RESULTS

Fifty-six interviews with 28 matched dyads were completed. In six dyads (21%), the participants reported differing results of the discussion. Two patients had orders to limit their care based on the physician's interpretation of their discussion. Another two patients who did not want resuscitation lacked a DNR order. Two patients did not recall having the conversation. These discrepancies could be attributed to the physician misconstruing the patient's wishes, interference of a family member, and fluctuating preferences.

CONCLUSIONS

Discrepant interpretations of a DNR discussion occur with a concerning frequency between resident physicians and their hospitalized patients.

PRACTICE IMPLICATIONS

Educational efforts should focus on training physicians to clarify the language used in these discussions, remain vigilant about discerning the patient's preferences, and be aware that these preferences may be contextually fluid.