Choice of Diction's Effect (CODE)

Rutgers The State University of New Jersey

Status: Unknown

Conditions: Decision Making; Cardiopulmonary Resuscitation; Advance Directives; Communication

Treatments: Other: Standard of care for no code; Other: Alternative phrasing for no code

Study type: Interventional

Funder types: Other

Identifiers

NCT04896411

Pro2020002188

Details and patient eligibility

About

The purpose of the research is to determine how the language used when discussing preferences about cardiopulmonary resuscitation (CPR) affects decisions regarding this (code status)

Full description

Most Americans express a preference for dying at home naturally and surrounded by loved ones. However, many also believe that cardiopulmonary resuscitation (CPR) is more effective than it is, and want to have CPR even when the chances for a good outcome is poor. Among other reasons, the alternative term (Do Not Resuscitate, or DNR) has been shown in the literature to be associated by patients with passive, sub-optimal, and low quality care.

This study will attempt to determine patient preference for the "no CPR" term on patients admitted to the hospital using alternate phrasing. During admission to the Medical Teaching Service, patients over the age of 65 who are able to consent and who are not critically ill/unstable will be approached. After checking brief background questions (such as if they ever had discussions like these before), they will be randomized into two groups and asked code status using one of the two phrases. This question will determine the patient's "code status;" asking for this is a routine part of hospitalized care that is required by law (the exact terminology is left to the care team). After determining the patient's code status, they will be asked how satisfied they were with the decision; the investigator will be asked if they agree with the decision separately. Demographic and clinical information will be collected. Six months later, the patient will be contacted again; at this time, they will be asked about recent life and health changes. Finally, they will be asked their code status one more time. This will conclude the participant's involvement in the study

Enrollment: 100 estimated patients

Sex: All

Ages: 65+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 65 or older
• English-fluency in reading and speaking
• Capacity to consent

Exclusion criteria

• Unstable psychiatric illness
• Unstable/critically ill patients requiring ICU-level care
• Active substance abuse

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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100 participants in 2 patient groups

Alternative Phrase

Experimental group

Description:

This arm will have the code status question randomized to offer CPR vs the alternative phrase

Treatment:

Other: Alternative phrasing for no code

Standard of care phrase

Active Comparator group

Description:

This arm will have the code status question randomized to offer CPR vs the standard of care phrase

Treatment:

Other: Standard of care for no code