Use of a standardized code status explanation by residents among hospitalized patients

Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Practice implications: Standardized discussion of code status and training in communication of end-of-life care merit further research. Keywords: Code status; physician–patient communication; end-of-life discussion; cardiopulmonary resuscitation To access the supplementary material for this article, please see Supplementary files under Article Tools online. (Published: 14 April 2014) Citation: Journal of Community Hospital Internal Medicine Perspectives 2014, 4 : 23745 - http://dx.doi.org/10.3402/jchimp.v4.23745