Mittal Kriti, Sharma Kapil, Dangayach Neha, Raval Dhaval, Leung Katherine, George Susan, Abraham George
Cleveland Clinic, Cleveland, OH, USA.
Division of Hospital Medicine, Brown University, Providence, RI, USA.
J Community Hosp Intern Med Perspect. 2014 Apr 14;4(2). doi: 10.3402/jchimp.v4.23745. eCollection 2014.
There is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.
This was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.
The composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.
The scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.
Standardized discussion of code status and training in communication of end-of-life care merit further research.
住院患者中，住院医师对代码状态的讨论存在很大差异。本研究的主要目的是确定一份书面代码状态解释对患者理解与代码状态及临终关怀相关选择的影响。
这是在一家教学医院进行的单中心随机试验。患者被随机分为对照组（仅问卷调查）或干预组（标准化解释 + 问卷调查）。根据患者回答生成一个综合分数以评估理解情况。
干预组的综合分数为5.27，而对照组为4.93（p = 0.066）。老年患者（p < 0.001）、患有多种合并症的患者（p≤0.001）、KATZ分数<6的患者（p = 0.008）以及住在辅助生活设施/养老院的患者（p = 0.005）的分数较低。患者对根据代码状态接受胸外按压、静脉输液和管饲的能力的理解存在显著差异。
书面代码状态解释并未对综合分数产生显著影响。年龄、合并症、功能状态和居住类型与患者对代码状态选择的理解存在显著关联。
代码状态的标准化讨论以及临终关怀沟通方面的培训值得进一步研究。
