Shared Decision Making in Code Status Determination

Background: The prognosis of in-hospital cardiac arrest (IHCA) is poor, with few such patients leaving the hospital alive and neurologically intact. A critical part of advance care planning is assuring the patient’s and family's education and wishes so that their goals of care may be honored. Studies have previously demonstrated that many patients and families overestimate the likelihood of survival with an acceptable status after IHCA and may, therefore, wish a 'full code' status. Objective: To determine if concepts of frank education and shared-decision making might be associated with increased likelihood of do-not-resuscitate (DNR) orders and decision certainty. Design: Pragmatic, multicenter, cluster-randomized controlled trial. Methods: Between 2019 and 2023, residents at 6 Swiss teaching hospitals were randomized to either usual care or to a group typified by education and a shared decision-making checklist with observation and patient or family feedback. In all, 206 resi more...